Ampullary Region Carcinomas

• DOI: 10.1097/pas.0b013e31826399d8
• Publication Date: 2012-10-01T02:54:47Z
• Authors: Volkan Adsay; Nobuyuki Ohike; Takuma Tajiri; Grace E. Kim; Alyssa Krasinskas; Serdar Balci; Pelin Bagci; Olca Basturk; Sudeshna Bandyopa...; Kee-Taek Jang; David A. Kooby; Shishir K. Maithel; Juan Sarmiento; Charles A. Staley; Raul S. Gonzalez; So Yeon Kong; Michael Goodman
• Keywords: Male; Ampulla of Vater; Duodenum; Common Bile Duct Neoplasms; Adenocarcinoma; Middle Aged; United States; Pancreaticoduodenectomy; 3. Good health; Pancreatic Neoplasms; Survival Rate; 03 medical and health sciences; Sex Factors; 0302 clinical medicine; Humans; Female; Neoplasm Invasiveness; Lymph Nodes; Aged

Ampullary (AMP) carcinomas comprise a heterogeneous group of cancers lacking adequate subcategorization. In the present study, 249 strictly defined primary AMP (ACs) identified in 1469 malignant pancreatoduodenectomy specimens were analyzed for defining features. Gross and microscopic findings used to determine tumor epicenter extent preinvasive component. ACs classified into 4 distinct subtypes based on location: (1) Intra-AMP (25%): Invasive arising intra-ampullary papillary-tubular neoplasms with zero minimal, duodenal surface involvement (<25% tumor). These tumors more commonly found men, they had relatively large overall size (mean, 2.9 cm) but smaller invasive component 1.5 cm), predominantly lower TNM stage (85%, T1/2; 72% N0). They carried best prognosis among groups (3-y survival, 73%). (2) AMP-ductal (15%): forming constrictive, sclerotic, plaque-like thickening walls common bile duct and/or pancreatic resulting mucosa-covered, button-like elevations papilla lumen. There was no significant exophytic (preinvasive) growth. smallest (mean size, 1.9 cm; mean invasion 1.7 worst 41%), presumably due pancreatobiliary histology/origin (in 86%); however, even this significantly better when compared 113 ordinary ductal adenocarcinomas (3 y, 11%; P<0.0001). (3) Peri-AMP-duodenal (5%): Massive exophytic, ulcero-fungating growing lumen eccentrically encasing ampullary orifice only minimal luminal involvement. mostly intestinal phenotype (75%) some mucinous Although these largest 4.7 3.4 highest incidence lymph node metastasis (50%), an intermediate 69%) that seen 55 nonampullary carcinoma controls. (4) AC-not otherwise specified ("papilla Vater"; 55%): Ulcero-nodular located at Vater, which do not show specific characteristics other 3 subtypes. conclusion, clinicopathologic are prognostically distinct.