Tumors of the ampulla of vater

Abstract

Ampullary tumors are relatively rare, but the occurrence of biliary obstruction early in the disease course facilitates diagnosis. With technologic advances, methods of diagnosis, treatment, and management of ampullary tumors are constantly evolving. However, despite rapid improvements in these areas, preoperative differentiation between adenomas and adenocarcinomas remains difficult. Forcep biopsy specimens can accurately detect the presence or absence of adenomatous changes, but they have a high false-negative rate for adenocarcinoma. Whereas it is generally agreed that all ampullary tumors should be removed or resected, patient selection for the various treatments, including pancreatoduodenectomy, local resection, and endoscopic treatment, remains controversial. Stage of disease, patient characteristics (ie, age and comorbid conditions), and local availability of expertise determine treatment options.

Gastrointestinal Hyperplasia with Altered Expression of DNA Polymerase β

“…Duodenal epithelial tumors that develop from the intestinal type or the pancreaticobiliary type mucosa of Vater's papilla [72], [73] are relatively rare tumors in humans; the incidence rate of adenoma is 0.04–0.62% and that of carcinoma is 0.2% in postmortem or autopsy studies [74]. Molecular alterations in these duodenal lesions are similar to those of colorectal tumors and include K-ras mutation and the overexpression of p53, p21/Waf1, p16, and/or APC [72], [73], [75].…”

Pancreato-Biliary Cancers – Diagnosis and Management

“…Whilst ampullary tumours can occur sporadically, they are often seen in the context of genetic syndromes such as familial adenomatous polyposis and hereditary non-polyposis colorectal cancer, in whom the risk is 100 times more than the general population (Offerhaus et al, 1992). As endoscopic screening and surveillance program is adopted for these at-risk individuals, most tumours are adenomas at detection, though the potential of malignant transformation to carcinomas is high (Jean and Dua, 2003;Fischer and Zhou, 2004). Currently, there is no consensus on the management of ampullary tumors.…”

Advances in diagnostic endoscopy for duodenal, including ampullary, adenoma

“…Unfortunately, random biopsies have been associated with a wide range of accuracy for adenoma diagnosis (40–85%) . Therefore, the standard protocol for non‐ampullary and ampullary tumor surveillance is still not settled …”

“…Certain ampullary neoplasms may present early with obstructive jaundice or pancreatitis, as a small lesion can cause obstruction of the ampullary orifice, whereas almost all non-ampullary neoplasms are incidentally discovered during a routine endoscopy. [1][2][3] In contrast, almost all symptomatic patients with non-ampullary neoplasm presenting with GI bleeding or bowel obstruction are usually discovered at an advanced stage and their prognosis is dismal. 4,5 Therefore, early diagnosis is important to improve survival.…”