Pancreatic Pathology Online
Reporting of Ampullary and Periampullary Biopsies for the Diagnosis of Neoplastic Lesions
Dr Sampurna Roy MD July 2016
These biopsy specimens are almost invariably taken at ERCP (Endoscopic retrograde cholangiopancreatography ).
Assessment can be particularly difficult because of the small size of the specimen, poor orientation and crush artifact.
In patients with familial adenomatous polyposis, periampullary adenomas are very common and may carpet the second and third parts of the duodenum.
In these patients, hyperplasia, adenoma and carcinoma may coexist.
Malignant tumours of the periampullary area occur less frequently than in the pancreas, except in patients with familial adenomatous polyposis.
They are nonetheless important as they have a better prognosis than carcinoma of the pancreas.
Neoplasia can arise in the terminal bile duct, the duodenal mucosa, the ampulla itself, and very rarely in Brunner's glands.
Adenocarcinomas in this area are usually intestinal in type rather than more desmoplastic and infiltrative type which occur in the pancreas.
The report should comment on the presence of:
- Type: villous, tubular, tubulovillous ;
- Degree of dysplasia ;
- Focal mucosal or submucosal invasion.
- Malignant neoplasm ;
- Type: carcinoma, lymphoma, sarcoma;
- Grades ;
- Spread: perineural or intravascular.
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