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Difference between revisions of "Ampulla of Vater"
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#Pancreaticobiliary ampullary carcinoma. | #Pancreaticobiliary ampullary carcinoma. | ||
#Other. | #Other. | ||
[[File:1 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | [[File:1 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | ||
[[File:2 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | [[File:2 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | ||
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[[File:5 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | [[File:5 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | ||
[[File:6 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | [[File:6 amp ca 1 680x512px.tif|Invasive carcinoma of duodenal ampulla.]] | ||
Invasive carcinoma of duodenal ampulla, intestinal type. A. Ulceration tops Brunner’s glands [green arrow]; at the edge lie glands [blue arrow] with changes suggesting adenoma (100X). B. Ki67 stain establishes adenoma by surface extension of brown nuclei (100X). C. The lesion was a mass, prompting rebiopsy. The cauterized fragment shows disorderly spread of glands, with dilated glands at base [arrows] not readily explained by obstruction (40X) D.Two cancerous prongs, one on left [black arrow], one on right [blue arrow] each show spread about muscle fibers (200X). E. The Whipple resection showed the same dilated spreading glands [arrows] at base, redolent of the spread of some well-differentiated colonic adenocarcinomas through muscle (40X). F. Cribriformed cancerous nests [arrows] cannot be Brunner’s glands, because the nuclei are too variable and lack polarity and because they abut crypts extending to the surface; cautery would have made this an impossible distinction (200X). | Invasive carcinoma of duodenal ampulla, intestinal type. A. Ulceration tops Brunner’s glands [green arrow]; at the edge lie glands [blue arrow] with changes suggesting adenoma (100X). B. Ki67 stain establishes adenoma by surface extension of brown nuclei (100X). C. The lesion was a mass, prompting rebiopsy. The cauterized fragment shows disorderly spread of glands, with dilated glands at base [arrows] not readily explained by obstruction (40X) D.Two cancerous prongs, one on left [black arrow], one on right [blue arrow] each show spread about muscle fibers (200X). E. The Whipple resection showed the same dilated spreading glands [arrows] at base, redolent of the spread of some well-differentiated colonic adenocarcinomas through muscle (40X). F. Cribriformed cancerous nests [arrows] cannot be Brunner’s glands, because the nuclei are too variable and lack polarity and because they abut crypts extending to the surface; cautery would have made this an impossible distinction (200X). | ||
[[File:5 08466787961551 sl 1.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 2.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 3.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 4.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 5.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 6.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
[[File:5 08466787961551 sl 7.png| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]] | |||
60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver. A. An isolated tumor fragment (black arrow) and two fragments with tumor undermining small intesatinal mucosa (green arrows) are seen. B. Large, ovoid cancer nuclei with abundant grey cytoplasm form sheets with only rare acini (arrow). C. Tumor cells are CK7 positive. D. Tumor cells are CK20 negative. E. Portal triads (black arrows) are expanded, lacking intense inflammation. A septal duct (green arrow) lacks definite onion skinning. F. Proliferated peripheral bile ductules (black arrows) sometimes have neutrophils (white arrow), which should not be interpreted as ascending cholangitis. Next to the artery (red arrow) lies the bile duct (yellow arrow), which has disturbed nuclei, but no neutrophils. Note occasional eosinophils (cyan arrows). G. Hepatocytes with feathery degeneration. Arrows point to dilated cholangioles, one filled with a bile plug. | |||
Notes: | Notes: | ||