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.

Mentioned in ?

pneumobilia

References in periodicals archive ?

Pancreaticogastrostomy for reconstruction of pancreatic stump after pancreaticoduodenectomy for ampullary carcinoma.

Pancreaticogastrostomy - an alternate for dealing with pancreatic remnant after pancreaticoduodenectomy - experience from a tertiary care center of Pakistan

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.

Evaluation of pancreatico-biliary disease by MRCP

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).

Percutaneous transhepatic self-expanding metal stents for palliation of malignant biliary obstruction

Histopathology revealed an ampullary carcinoma infiltrating the superficial part of pancreas.

Periampullary carcinoma in a patient with agenesis of dorsal 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.

Ampullary tumours (ampullomas) in the elderly--an interdisciplinary problem

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.

Iron deficiency is one of the commonest causes of anaemia in adults

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.

Endoscopic retrograde cholangiopancreatography in elderly patients

PANCREATIC DUCTAL ADENOCARCINOMA VERSUS DISTAL BILE DUCT AND AMPULLARY CARCINOMA

Difficult Diagnostic Problems in Pancreatobiliary Neoplasia. (Special Section--HSCP 2014 Spring Symposium, Part II)

Gambill (33) found significant pancreatitis in 26 (10%) of 255 patients with pancreatic or ampullary carcinoma.

Pancreatic carcinoma: review of literature

This anatomic difficulty may cause some problems in T classification for ampullary carcinoma (AC).

Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?

Total of 56 samples of various upper gastrointestinal carcinomas were included in study of which 17 were of esophagus, 28 samples were of carcinoma stomach and 11 were of ampullary carcinoma.

Ki-67 proliferation index and clinicopathological patterns in upper gastrointestinal tract carcinomas