Ampullary Hamartoma: A Rare Cause of Biliary Obstruction

Backgrounds/AimsSurgical resection, such as pancreaticoduodenectomy (PD), is used for treatment of benign periampullary tumors, but high morbidity and mortality resulting from PD can be a huddle. The aim of this study is to suggest a safe and less invasive procedure for treatment of benign periampullary tumors.MethodsFrom January 2001 to September 2016, 31 patients with ampulla of Vater (AOV) tumors were reviewed retrospectively. Patients who were confirmed with malignancy through biopsy were excluded, except for one patient with malignancy and multiple underlying diseases. To investigate the safety and availability of transduodenal ampullectomy (TDA), TDA and endoscopic papillectomy (EP) were compared.ResultsThere was no significant difference in the occurrence of complications between the TDA group and EP group (p=0.145), and the resection margins were negative in both groups. There was no recurrence in patients who had TDA, while one patient had a recurrence after EP.ConclusionsThis study suggests that TDA is as safe as EP for treating benign periampullary tumors.

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“… 1 The most common benign lesions are adenomas. 2 3 Ampullary adenomas may possibly progress to carcinoma. 4 …”

Section: Introductionmentioning

confidence: 99%

Safety of duodenal ampullectomy for benign periampullary tumors

Kim

Choi

2017

Ann Hepatobiliary Pancreat Surg

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“…In the WHO classification, adenomyoma is defined as a tumorlike lesion of extrahepatic bile ducts (2). Morphological analyses of individual cases have been reported previously (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). The total number of cases does not exceed 20.…”

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confidence: 99%

Adenomyoma and Adenomyomatous Hyperplasia of the Vaterian System: Clinical, Pathological, and New Immunohistochemical Features of 13 Cases

et al. 2003

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Adenomyoma and adenomyomatous hyperplasia of the Vaterian system are consistently benign lesions. Clinically, adenomyoma mimics frequently ampullary adenoma or carcinoma, and biopsy analysis is often difficult. The histogenesis of ampullary adenomyoma and adenomyomatous hyperplasia is still subject to debate. We present a retrospective study of clinicopathological features of 13 cases of surgically resected ampullary adenomyoma. The age of our patients was between 38 and 78 years (mean: 63 y). The preoperative diagnosis was ampullary tumor or tumor of the head of the pancreas. On macroscopy, a white, firm lesion of the ampullary wall was observed; its size ranged between 10 and 30 mm. Histologically the lesion consisted of multiple glandular structures surrounded by a fibroblastic/ myofibroblastic proliferation, resulting in a "pseudo-hypertrophy" of the Vaterian system. The immunophenotype of the epithelial component was cytokeratin 7؉/cytokeratin 20؊, similar to that of the normal biliary and pancreatic duct system. The epithelial cells exhibited low proliferative activity. The hyperplastic myofibroblastic cells expressed smooth muscle actin. A complete pancreatic heterotopy contiguous with the adenomyoma was noted in three cases. Adenomyoma and adenomyomatous hyperplasia of the Vaterian system are benign lesions frequently treated by extensive surgery because of long-term biliary obstruction. The clinicopathological characteristics suggest either a reactive and/or a malformative, nonneoplastic nature for this lesion, which could, in some cases, develop from heterotopic pancreas. The immunophenotype of epithelial cells may be a useful tool for differentiating it from ampullary adenoma on biopsy specimens.

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“…Adenomas or adenocarcinomas representing > 95% of these lesions [21,22] . AA are benign lesions but, can potencially develop into ampullary carcinomas in a comparable progression to that of colorectal cancer [2,3,[23][24][25][26][27][28][29] .…”

Section: Epidemiologymentioning

confidence: 99%

Endoscopic management of adenomatous ampullary lesions

Espinel¹

2015

WJM

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Lesions of the ampulla of Vater represent an uncommon group of gastrointestinal malignancies. The majority of lesions of the ampulla of Vater are either adenomas or adenocarcinomas. Ampullary lesions are often incidental findings. Accurate preoperative diagnosis and staging of ampullary tumors is imperative for predicting prognosis and determining the most appropriate therapeutic approach. Endoscopic ampullectomy is a safe and efficacious therapeutic procedure that can obviate the need for potentially major surgical intervention. This review will provide the framework for the diagnosis and management of ampullary lesions from the perspective of the practicing gastroenterologist. Strategies for safe and successful endoscopic ampullectomy with a focus on accurate preoperative diagnosis and staging, resection technique, and management of complications are presented. Core tip: Adenomatous ampullary lesions are rare. Endoscopic retrograde cholangiopancreatography and endoscopic ultrasound (EUS) have changed the management of patients with these lesions. Endoscopic ampullectomy is a technique that has revolutionized the treatment of these lesions avoiding potential complications of surgery. We herein discuss the epidemiology, the role of EUS in the local staging and the role of endoscopy in the treatment of the adenomatous ampullary neoplasms.Espinel J, Pinedo E, Ojeda V, Guerra del Rio M. Endoscopic management of adenomatous ampullary lesions. World J REVIEW

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Ampullary Hamartoma: A Rare Cause of Biliary Obstruction

Cited by 17 publications

References 9 publications

Safety of duodenal ampullectomy for benign periampullary tumors

Safety of duodenal ampullectomy for benign periampullary tumors

Adenomyoma and Adenomyomatous Hyperplasia of the Vaterian System: Clinical, Pathological, and New Immunohistochemical Features of 13 Cases

Endoscopic management of adenomatous ampullary lesions

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