Ampullary Adenocarcinoma and Variants



Ampullary Adenocarcinoma and Variants


Mari Mino-Kenudson, MD









From the luminal aspect of this resection specimen, the ampulla is replaced by a protruding tumor grossly involving the duodenal mucosa of the papilla and periampullary duodenum.






This ampullary adenocarcinoma consists of an exophytic white tumor involving the orifice image of the common bile duct image, but not invading the pancreatic duct image.


TERMINOLOGY


Synonyms



  • Periampullary adenocarcinoma


Definitions



  • Adenocarcinoma arising in ampullary region and periampullary duodenal adenocarcinoma are collectively termed “ampullary adenocarcinoma”



    • Approximately 90% of all carcinomas of region


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Relatively uncommon



      • Approximately 0.2% of GI tract malignancies


      • Ampulla is most common site of small bowel adenocarcinoma


  • Age



    • Most common in 7th-8th decade of life


    • Patients with familial adenomatous polyposis develop ampullary carcinoma at younger age than patients with sporadic cases


  • Gender



    • Slightly more common in men (M:F = 1.48:1)


Presentation



  • Jaundice


  • Weight loss


  • Abdominal pain


  • Distended, palpable gallbladder (Courvoisier sign)


Treatment



  • Resection (Whipple procedure)



    • Resectability is approximately 60%


  • Role of adjuvant chemoradiation therapy (5-FU based) is controversial


Prognosis



  • 5-year survival rate after surgical resection is approximately 50%



    • Significantly better than that of pancreatic adenocarcinoma


    • Comparable to that of duodenal adenocarcinoma

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ampullary Adenocarcinoma and Variants
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