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Ampullary Carcinoma
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Heterogeneous group of malignant epithelial neoplasms (adenocarcinoma) arising from ampulla of Vater

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Radiographic Findings

                      • Fluoroscopic Findings

                        • Angiographic Findings

                          • Nuclear Medicine Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Staging, Grading, & Classification

                                    • Gross Pathologic & Surgical Features

                                      • Microscopic Features

                                        CLINICAL ISSUES

                                        • Presentation

                                          • Demographics

                                            • Natural History & Prognosis

                                              • Treatment

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  • Image Interpretation Pearls

                                                    Selected References

                                                    1. Raman SP et al: Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging. AJR Am J Roentgenol. 203(1):17-28, 2014
                                                    2. Jang KM et al: Added value of diffusion-weighted MR imaging in the diagnosis of ampullary carcinoma. Radiology. 266(2):491-501, 2013
                                                    3. Westgaard A et al: Intestinal-type and pancreatobiliary-type adenocarcinomas: how does ampullary carcinoma differ from other periampullary malignancies? Ann Surg Oncol. 20(2):430-9, 2013
                                                    4. Chung YE et al: Differentiation of benign and malignant ampullary obstructions on MR imaging. Eur J Radiol. 80(2):198-203, 2011
                                                    5. Chung YE et al: Differential features of pancreatobiliary- and intestinal-type ampullary carcinomas at MR imaging. Radiology. 257(2):384-93, 2010
                                                    6. Barauskas G et al: Tumor-related factors and patient's age influence survival after resection for ampullary adenocarcinoma. J Hepatobiliary Pancreat Surg. 15(4):423-8, 2008
                                                    7. Carter JT et al: Tumors of the ampulla of vater: histopathologic classification and predictors of survival. J Am Coll Surg. 207(2):210-8, 2008
                                                    8. Chen WX et al: Multiple imaging techniques in the diagnosis of ampullary carcinoma. Hepatobiliary Pancreat Dis Int. 7(6):649-53, 2008
                                                    9. O'Connell JB et al: Survival after resection of ampullary carcinoma: a national population-based study. Ann Surg Oncol. 15(7):1820-7, 2008
                                                    10. Schirmacher P et al: Ampullary adenocarcinoma - differentiation matters. BMC Cancer. 8:251, 2008
                                                    11. Singh S et al: Palliative surgical bypass for unresectable periampullary carcinoma. Hepatobiliary Pancreat Dis Int. 7(3):308-12, 2008
                                                    12. Smith RA et al: Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio. J Gastrointest Surg. 12(8):1422-8, 2008
                                                    13. Ahualli J: The double duct sign. Radiology. 244(1):314-5, 2007
                                                    14. Sugita R et al: Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens. Radiology. 231(3):767-74, 2004
                                                    15. Clements WM et al: Ampullary carcinoid tumors: rationale for an aggressive surgical approach. J Gastrointest Surg. 7(6):773-6, 2003
                                                    16. Duffy JP et al: Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg. 138(9):941-8; discussion 948-50, 2003
                                                    17. Handra-Luca A et al: Adenomyoma and adenomyomatous hyperplasia of the Vaterian system: clinical, pathological, and new immunohistochemical features of 13 cases. Mod Pathol. 16(6):530-6, 2003
                                                    18. Lindell G et al: Management of cancer of the ampulla of Vater: does local resection play a role? Dig Surg. 20(6):511-5, 2003
                                                    19. Martin JA et al: Ampullary adenoma: clinical manifestations, diagnosis, and treatment. Gastrointest Endosc Clin N Am. 13(4):649-69, 2003
                                                    20. Nakano K et al: Combination therapy of resection and intraoperative radiation for patients with carcinomas of extrahepatic bile duct and ampulla of Vater: prognostic advantage over resection alone? Hepatogastroenterology. 50(52):928-33, 2003
                                                    21. Smith TR et al: Prolapse of the common bile duct with small ampullary villous adenocarcinoma into third part of the duodenum. AJR Am J Roentgenol. 181(2):599-600, 2003
                                                    22. Trimbath JD et al: Attenuated familial adenomatous polyposis presenting as ampullary adenocarcinoma. Gut. 52(6):903-4, 2003
                                                    23. Irie H et al: MR imaging of ampullary carcinomas. J Comput Assist Tomogr. 26(5):711-7, 2002
                                                    24. Jordan PH Jr et al: Treatment of ampullary villous adenomas that may harbor carcinoma. J Gastrointest Surg. 6(5):770-5, 2002
                                                    25. Kaiser A et al: The adenoma-carcinoma sequence applies to epithelial tumours of the papilla of Vater. Z Gastroenterol. 40(11):913-20, 2002
                                                    26. Kim JH et al: Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics. 22(6):1335-52, 2002
                                                    27. Rodriguez C et al: How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours? Rev Esp Enferm Dig. 94(10):585-92, 2002
                                                    28. Skordilis P et al: Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. BMC Surg. 2(1):1, 2002
                                                    29. Yoshida T et al: Hepatectomy for liver metastasis from ampullary cancer after pancreatoduodenectomy. Hepatogastroenterology. 49(43):247-8, 2002
                                                    30. Eriguchi N et al: Carcinoma of the ampulla of Vater associated with other organ malignancies. Kurume Med J. 48(4):255-9, 2001
                                                    31. Hirata S et al: Periampullary choledochoduodenal fistula in ampullary carcinoma. J Hepatobiliary Pancreat Surg. 8(2):179-81, 2001
                                                    32. Nikfarjam M et al: Local resection of ampullary adenocarcinomas of the duodenum. ANZ J Surg. 71(9):529-33, 2001
                                                    33. Wagle PK et al: Pancreaticoduodenectomy for periampullary carcinoma. Indian J Gastroenterol. 20(2):53-5, 2001
                                                    34. Wittekind C et al: Adenoma of the papilla and ampulla--premalignant lesions? Langenbecks Arch Surg. 386(3):172-5, 2001
                                                    35. Yeo CJ et al: Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg. 227(6):821-31, 1998
                                                    36. Talamini MA et al: Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 225(5):590-9; discussion 599-600, 1997
                                                    Related Anatomy
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                                                    Related Differential Diagnoses
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                                                    References
                                                    Tables

                                                    Tables

                                                    KEY FACTS

                                                    • Terminology

                                                      • Imaging

                                                        • Top Differential Diagnoses

                                                          • Pathology

                                                            • Clinical Issues

                                                              TERMINOLOGY

                                                              • Definitions

                                                                • Heterogeneous group of malignant epithelial neoplasms (adenocarcinoma) arising from ampulla of Vater

                                                              IMAGING

                                                              • General Features

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Radiographic Findings

                                                                        • Fluoroscopic Findings

                                                                          • Angiographic Findings

                                                                            • Nuclear Medicine Findings

                                                                              • Imaging Recommendations

                                                                                DIFFERENTIAL DIAGNOSIS

                                                                                  PATHOLOGY

                                                                                  • General Features

                                                                                    • Staging, Grading, & Classification

                                                                                      • Gross Pathologic & Surgical Features

                                                                                        • Microscopic Features

                                                                                          CLINICAL ISSUES

                                                                                          • Presentation

                                                                                            • Demographics

                                                                                              • Natural History & Prognosis

                                                                                                • Treatment

                                                                                                  DIAGNOSTIC CHECKLIST

                                                                                                  • Consider

                                                                                                    • Image Interpretation Pearls

                                                                                                      Selected References

                                                                                                      1. Raman SP et al: Abnormalities of the Distal Common Bile Duct and Ampulla: Diagnostic Approach and Differential Diagnosis Using Multiplanar Reformations and 3D Imaging. AJR Am J Roentgenol. 203(1):17-28, 2014
                                                                                                      2. Jang KM et al: Added value of diffusion-weighted MR imaging in the diagnosis of ampullary carcinoma. Radiology. 266(2):491-501, 2013
                                                                                                      3. Westgaard A et al: Intestinal-type and pancreatobiliary-type adenocarcinomas: how does ampullary carcinoma differ from other periampullary malignancies? Ann Surg Oncol. 20(2):430-9, 2013
                                                                                                      4. Chung YE et al: Differentiation of benign and malignant ampullary obstructions on MR imaging. Eur J Radiol. 80(2):198-203, 2011
                                                                                                      5. Chung YE et al: Differential features of pancreatobiliary- and intestinal-type ampullary carcinomas at MR imaging. Radiology. 257(2):384-93, 2010
                                                                                                      6. Barauskas G et al: Tumor-related factors and patient's age influence survival after resection for ampullary adenocarcinoma. J Hepatobiliary Pancreat Surg. 15(4):423-8, 2008
                                                                                                      7. Carter JT et al: Tumors of the ampulla of vater: histopathologic classification and predictors of survival. J Am Coll Surg. 207(2):210-8, 2008
                                                                                                      8. Chen WX et al: Multiple imaging techniques in the diagnosis of ampullary carcinoma. Hepatobiliary Pancreat Dis Int. 7(6):649-53, 2008
                                                                                                      9. O'Connell JB et al: Survival after resection of ampullary carcinoma: a national population-based study. Ann Surg Oncol. 15(7):1820-7, 2008
                                                                                                      10. Schirmacher P et al: Ampullary adenocarcinoma - differentiation matters. BMC Cancer. 8:251, 2008
                                                                                                      11. Singh S et al: Palliative surgical bypass for unresectable periampullary carcinoma. Hepatobiliary Pancreat Dis Int. 7(3):308-12, 2008
                                                                                                      12. Smith RA et al: Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9 levels and platelet-lymphocyte ratio. J Gastrointest Surg. 12(8):1422-8, 2008
                                                                                                      13. Ahualli J: The double duct sign. Radiology. 244(1):314-5, 2007
                                                                                                      14. Sugita R et al: Periampullary tumors: high-spatial-resolution MR imaging and histopathologic findings in ampullary region specimens. Radiology. 231(3):767-74, 2004
                                                                                                      15. Clements WM et al: Ampullary carcinoid tumors: rationale for an aggressive surgical approach. J Gastrointest Surg. 7(6):773-6, 2003
                                                                                                      16. Duffy JP et al: Improved survival for adenocarcinoma of the ampulla of Vater: fifty-five consecutive resections. Arch Surg. 138(9):941-8; discussion 948-50, 2003
                                                                                                      17. Handra-Luca A et al: Adenomyoma and adenomyomatous hyperplasia of the Vaterian system: clinical, pathological, and new immunohistochemical features of 13 cases. Mod Pathol. 16(6):530-6, 2003
                                                                                                      18. Lindell G et al: Management of cancer of the ampulla of Vater: does local resection play a role? Dig Surg. 20(6):511-5, 2003
                                                                                                      19. Martin JA et al: Ampullary adenoma: clinical manifestations, diagnosis, and treatment. Gastrointest Endosc Clin N Am. 13(4):649-69, 2003
                                                                                                      20. Nakano K et al: Combination therapy of resection and intraoperative radiation for patients with carcinomas of extrahepatic bile duct and ampulla of Vater: prognostic advantage over resection alone? Hepatogastroenterology. 50(52):928-33, 2003
                                                                                                      21. Smith TR et al: Prolapse of the common bile duct with small ampullary villous adenocarcinoma into third part of the duodenum. AJR Am J Roentgenol. 181(2):599-600, 2003
                                                                                                      22. Trimbath JD et al: Attenuated familial adenomatous polyposis presenting as ampullary adenocarcinoma. Gut. 52(6):903-4, 2003
                                                                                                      23. Irie H et al: MR imaging of ampullary carcinomas. J Comput Assist Tomogr. 26(5):711-7, 2002
                                                                                                      24. Jordan PH Jr et al: Treatment of ampullary villous adenomas that may harbor carcinoma. J Gastrointest Surg. 6(5):770-5, 2002
                                                                                                      25. Kaiser A et al: The adenoma-carcinoma sequence applies to epithelial tumours of the papilla of Vater. Z Gastroenterol. 40(11):913-20, 2002
                                                                                                      26. Kim JH et al: Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics. 22(6):1335-52, 2002
                                                                                                      27. Rodriguez C et al: How accurate is preoperative diagnosis by endoscopic biopsies in ampullary tumours? Rev Esp Enferm Dig. 94(10):585-92, 2002
                                                                                                      28. Skordilis P et al: Is endosonography an effective method for detection and local staging of the ampullary carcinoma? A prospective study. BMC Surg. 2(1):1, 2002
                                                                                                      29. Yoshida T et al: Hepatectomy for liver metastasis from ampullary cancer after pancreatoduodenectomy. Hepatogastroenterology. 49(43):247-8, 2002
                                                                                                      30. Eriguchi N et al: Carcinoma of the ampulla of Vater associated with other organ malignancies. Kurume Med J. 48(4):255-9, 2001
                                                                                                      31. Hirata S et al: Periampullary choledochoduodenal fistula in ampullary carcinoma. J Hepatobiliary Pancreat Surg. 8(2):179-81, 2001
                                                                                                      32. Nikfarjam M et al: Local resection of ampullary adenocarcinomas of the duodenum. ANZ J Surg. 71(9):529-33, 2001
                                                                                                      33. Wagle PK et al: Pancreaticoduodenectomy for periampullary carcinoma. Indian J Gastroenterol. 20(2):53-5, 2001
                                                                                                      34. Wittekind C et al: Adenoma of the papilla and ampulla--premalignant lesions? Langenbecks Arch Surg. 386(3):172-5, 2001
                                                                                                      35. Yeo CJ et al: Periampullary adenocarcinoma: analysis of 5-year survivors. Ann Surg. 227(6):821-31, 1998
                                                                                                      36. Talamini MA et al: Adenocarcinoma of the ampulla of Vater. A 28-year experience. Ann Surg. 225(5):590-9; discussion 599-600, 1997