ampullary carcinoma

ampullary carcinoma

A rare GI tract tumour that arises in the last centimetre of the common bile duct, comprising 7% of all periampullary malignancies. Ampullary carcinomas arise in ampullary adenomas; they usually have a better prognosis than pancreatic carcinomas, especially if the lesion is polypoid or papillary, and a worse prognosis if node-positive. The periampullary region is anatomically complex, representing the junction of three different epithelia: duodenal, pancreatic ductal, bile ductal, as well as a combination of the latter two (the ampulla of Vater).

Location
Intra-ampullary, periampullary, mixed, invasive pancreatic carcinoma.

Pathophysiology
Distinguishing between ampullary and periampullary tumours is critical, given that each type of mucosa produces a different pattern of mucus secretion (and prognosis): in general, ampullary tumours produce sialomucins and have a 100% 5-year survival, whereas periampullary tumours secrete sulfphated mucins and a 27% 5-year survival rate. Ampullary adenocarcinomas are classified as either:
(1) pancreaticobiliary—more aggressive, like that of pancreatic adenocarcinomas, CA 19-9 +ve; or
(2) intestinal—which have a prognosis similar to their duodenal counterparts, CA 19-9 –ve.
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References in periodicals archive ?
Ampullary carcinoma is often of mixed or hybrid histologic type: an analysis of reproducibility and clinical relevance ofclassification as pancreatobiliary versus intestinal in 232 cases.
Fischer, "Annular pancreas associated with coexistent ampullary carcinoma in an elderly woman," Canadian Journal of Surgery, vol.
Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma. Am J Surg 1998; 176: 274-8.
4: Sex-wise distribution of various Diseases as Observed on MRCP Male Female acute pancreatitis 10 chronic pancreatitis 4 cholelithiasis 4 choledocholelithiasis 6 cholelithiasis with 14 choledocholelithiasis choledochal cyst 2 gall bladder carcinoma 4 cholangiocarcinoma 6 peri ampullary carcinoma 4 stricture 4 Note: Table made from bar graph.
In contrast, retrospective evaluations of pancreatic cancer and ampullary carcinoma demonstrated that the number of metastatic nodes, but not LNR, was one of the most important prognostic factors [21, 22].
The most common malignancy in this study was pancreatic adenocarcinoma (n=24), followed by cholangiocarcinoma (n=11), gallbladder carcinoma (n=4), biliary compression by malignant nodes in the porta hepatis (n=4), and gastric (n=3), duodenal (n=2) and ampullary carcinoma (n=2).
Histopathology revealed an ampullary carcinoma infiltrating the superficial part of pancreas.
In conclusion, PDE is the treatment of choice not only for ampullary carcinoma but also for adenoma with high grade dysplasia also for elderly persons in good somatical status; (3,17) for frail unfit persons (19) with distant metastases or miscellaneous contraindications for surgery remains endoscopic sphincterotomy and stenting a valide alternative of palliative treatment.
Some GIT causes of asymptomatic iron deficiency anaemia and prevalence as percentage of total Occult GI blood loss Common Aspirin/NSAID use 10-15% Colonic carcinoma 5-10% Gastric carcinoma 5% Benign gastric ulceration 5% Angiodysplasia 5% Uncommon Oesophagitis 2-4% Oesophageal carcinoma 1-2% Gastric antral vascular ectasia 1-2% Small-bowel tumours 1-2% Ampullary carcinoma <1% Ancylomasta duodenale <1% Malabsorbtion Common Coeliac disease 4-6% Gastrectomy <5% H.
Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study.
Conclusion: in elderly patients, common bile duct stones often present atypically and co-existence with malignancy is not unusual; ampullary carcinoma has a relatively good prognosis and ERCP is a safe and effective procedure in the management of biliary obstruction.
Gambill (33) found significant pancreatitis in 26 (10%) of 255 patients with pancreatic or ampullary carcinoma. The presence of pancreatitis resultrd in a considerable delay in the diagnosis of carcinoma.