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Ampulla of vater carcinoma: Molecular landscape and clinical implications

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World Journal of Gastrointestinal Oncology 2018年第11期10卷 370-380页

作者： Antonio Pea Giulio Riva Riccardo Bernasconi Elisabetta Sereni Rita Teresa Lawlor Aldo Scarpa Claudio Luchini Department of Surgery University and Hospital Trust of Verona Department of Diagnostics and Public Health Section of Pathology University and Hospital Trust of Verona ARC-Net Research Center University and Hospital Trust of Verona

Ampulla of vater is a peculiar anatomical structure, characterized by the crossroad of three distinct epithelia: Intestinal, ductal pancreatic and biliary. Adenocarcinomas arising in this area represent an opportunity to understand the comparative biology of all periampullary malignancies. These neoplasms can exhibit intestinal, pancreaticobiliary or mixed features, whereas the subclassification based on morphology and immunohistochemical features failed in demonstrating a robust prognostic reliability. In the last few years, the molecular landscape of this tumor entity has been uncovered, identifying alterations that may serve as prognostic and predictive biomarkers. In this review, the histological and genetic characteristics of ampullary carcinomas are discussed, taking into account the main clinical and therapeutic implications related to this tumor type as well.

关键词： Pancreatobiliary Intestinal Mixed ELF3 TP53 KRAS Ampullary vater Histotype

Efficacy of cap-assisted endoscopy for routine examining the ampulla of vater

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World Journal of Gastroenterology 2013年第13期19卷 2037-2043页

作者： Young Rak Choi Joung-Ho Han Young Shim Cho Hye-Suk Han Hee Bok Chae Seon Mee Park Sei Jin Youn Department of Internal Medicine College of MedicineChungbuk National University

AIM: To determine the efficacy of a cap-assisted endoscopy (CAE) to completely visualize the ampulla of vater (AV) in patients failed by conventional endoscopy. METHODS: A prospective study was conducted on 120 patients > 20 years of ages who visited the Health Promotion Center of Chungbuk National University Hospital for conscious sedation esophagogastroduodenoscopy (EGD) as a screening test from July to October, 2011. First, forward-viewing endoscopy was performed with reasonable effort using a push and pull method. We considered complete visualization of the AV when we could observe the entire AV including the orifice clearly, and reported the observation as complete or incomplete (partial or not found at all). Second, in cases of complete failure of the observation, an additional AV examination was conducted by attaching a short cap (D-201-10704, Olympus Medical Systems, Tokyo, Japan) to the tip of a forward-viewing endoscope. Third, if the second method failed, we replaced the short cap with a long cap (MH-593, Olympus Medical Systems) and performed a re-examination of the AV. RESULTS: Conventional endoscopy achieved complete visualization of the AV in 97 of the 120 patients (80.8%) but was not achieved in 23 patients (19.2%). Age (mean ± SD) and gender [male (%)] were not significantly different between the complete observation and the incomplete observation groups. Additional short CAE was performed in patients in whom we could not completely visualize the AV. This group included 13 patients (10.9%) with partial observation of the AV and 10 (8.3%) in which the AV was not found. Short CAE permitted a complete observation of the AV in 21 of the 23 patients (91.3%). Patients in whom visualization of the AV failed with short CAE had satisfactory outcomes by replacing the short cap with a long cap. The additional time for CAE took an average of 141 ± 88 s. There were no complications and no significant mucosal trauma. CONCLUSION: CAE is safe to use as a salvage method to achieve complete visualization of the AV

关键词： Ampulla of vater Conventional endoscopy Cap-assisted endoscopy Screening test Complete oservation

Trends in incidence and management of cancer of the ampulla of vater

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World Journal of Gastroenterology 2014年第29期20卷 10144-10150页

作者： Florian Rostain Samia Hamza Antoine Drouillard Jean Faivre Anne-Marie Bouvier C?me Lepage Registre Bourguignon des Cancers Digestifs INSERM U866CHU de DijonFaculté de Médecine21079 Dijon CedexFrance

AIM:To provide trends in incidence,management and survival of cancer of the ampulla of vater in a welldefined French population.METHODS:Data were obtained from the populationbased digestive cancer registry of Burgundy over a34-year period.Age-standardized incidence rates were computed using the world standard population.Average annual variations in incidence rates were estimated using a poisson regression.A univariate and multivariate relative survival analysis was performed.RESULTS:Age-standardized incidence rates were0.46 and 0.30 per 100000 inhabitants for men and women,respectively.Incidence rate increased from0.26(1976-1984)to 0.58(2003-2009)for men and remained stable for women.Resection for cure was performed in 48.3%of cases.This proportion was stable over the study period.Among cases with curative resection,pancreatico-duodenectomy was performed in94.0%of cases and ampullectomy in 6.0%of cases.A total of 50.8%of cancers of the ampulla of vater were diagnosed at an advanced stage.Their proportion remained stable throughout the study period.The overall1-and 5-year relative survival rates were 60.2%and27.7%,respectively.Relative survival did not vary over time.Treatment and stage at diagnosis were the most important determinants of survival.The 5-year relative survival rate was 41.5%after resection for cure,9.5%after palliative surgery and 6.7%after symptomatic treatment.In multivariate analysis,only stage at diagnosis significantly influenced the risk of death.CONCLUSION:Cancer of the ampulla of vater is still uncommon,but its incidence increased for men in Burgundy.Diagnosis is often made at an advanced stage,dramatically worsening the prognosis.

关键词： Cancer of the ampulla of vater Incidence Survival

Gastrointestinal stromal tumor of the ampulla of vater:A case report

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World Journal of Gastroenterology 2014年第16期20卷 4817-4821页

作者： Masayoshi Kobayashi Nobuto Hirata So Nakaji Toshiyasu Shiratori Hiroyuki Fujii Eiji Ishii Department of Gastroenterology Kameda Medical CenterChiba 296-0041Japan

Gastrointestinal stromal tumors(GISTs)usually develop in the stomach and small intestine and only rarely occur at the ampulla of vater,with only 11 cases reported in the literature.We report a case of a GIST of the ampulla of vater.A 36-year-old,previously healthy man presented with a loss of consciousness lasting a few minutes.A gastroduodenal endoscopy revealed a submucosal tumor with central ulceration at the ampulla of vater.The enhanced computed tomography scan revealed a smooth-outlined hypervascular solid mass(24 mm×30 mm)in the second part of the duodenum.Neither lymphadenopathy nor metastasis was observed.Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed normal bile and pancreatic ducts.Biopsies were collected from the ulcerative lesion,and the tumor was diagnosed as a GIST.A submucosal tumor with central ulceration may be a characteristic form of GISTs of the ampulla of vater,and biopsy studies are useful for the diagnosing such tumors.The patient underwent pancreatoduodenectomy,and the operative specimen revealed a 2.2-cm GIST with 1 mitosis per 50 highpower fields.The gold standard for treatment of GISTs is surgical resection without rupture of a capsule.If technically possible,local resection may be considered.However,when the location of the lesion presents challenges,a pancreatoduodenectomy should be performed for GIST of the ampulla of vater.

关键词： Gastrointestinal stromal tumor Ampulla of vater Su

Tubercular Papillitis of vater

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International Journal of Clinical Medicine 2012年第6期3卷 469-472页

作者： Tateki Yamane Takayuki Ishii Akira Umeda Shigeharu Takagi Hitoshi Shimao Department of Surgery The International University of Health and Welfare Shioya Hospital Yaita Japan Division of Gastroenterology Department of Internal Medicine The International University of Health and Welfare Shioya Hospital Yaita Japan Division of Neurology Department of Internal Medicine The International University of Health and Welfare Shioya Hospital Yaita Japan Division of Pulmonology Department of Internal Medicine The International University of Health and Welfare Shioya Hospital Yaita Japan Sanikukai Family Clinic Funabashi Japan

A middle-aged man with no symptom or history visited our hospital due to duodenal abnormality and fecal occult blood detected by health screening. Upper gastrointestinal endoscopy showed marked enlargement of the papilla of vater surrounded by nodules, and biopsy disclosed non-caseating granuloma. Colonoscopy yielded findings suggestive of intestinal tuberculosis such as annular ulcers. Examination of the biopsy samples failed to make a diagnosis of tuberculosis, and no pulmonary lesion was found, but whole-blood interferon gamma release assay was positive. The duodenal lesion was also suspected to be tubercular, so antitubercular drugs were administered. As this resulted in the resolution of both lesions, a definite diagnosis of tubercular papillitis of vater was made. Duodenal tuberculosis is rare, and a localized lesion of the major duodenal papilla is extremely rare. However, this case suggests that tuberculosis must be considered in the differential diagnosis of lesions of the papilla of vater.

关键词： Duodenal Tuberticulosis Papillitis of vater Intestinal Tuberculosis

Obstructive Azoospermia in a Patient with vater Association

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Open Journal of Pathology 2012年第4期2卷 159-161页

作者： Zhanyong Bing Department of Pathology and Laboratory Medicine Hospital of the University of Pennsylvania Philadelphia USA

vater association was first described in 1968 by Say and Gerald and is an association of congenital anomalies including V (vertebral defect), A (anal atresia), TE (tracheoesophegeal fistula), and R (radial dysplasia and renal defects). This report described a 26 year-old man with vater association presented with infertility. Hormone tests including follicular stimulating hormone, luteinizing hormone and testosterone were normal. Semen analysis showed azoospermia. A testicular biopsy was performed and showed the presence of all of germinative components, germ cell sloughing, and mild hypospermatogenesis. The findings were compatible with obstructive azoospermia. No evidence of intratubular germ cell neoplasia unclassified was identified.

关键词： vater Association Obstructive Azoospermia

Pancreatolithiasis with an anatomic variant of Wirsung duct:a case report

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Gastroenterology Report 2023年第1期11卷 585-587页

作者： Satoshi Yamamoto Kazuo Inui Yoshiaki Katano Senju Hashimoto Hironao Miyoshi Takashi Kobayashi Yoshihiko Tachi Department of Gastroenterology Fujita Health University Bantane HospitalOtoubashiNakagawa-kuNagoyaAichiJapan Department of Gastroenterology Yamashita HospitalNakamachiIchinomiyaAichiJapan Board Chairman Geriatric Health Services Facility YukiMizuhomachiHandaAichiJapan Department of Gastroenterology Fujita Health University Okazaki Medical CenterHarisakichoOkazakiAichiJapan

Introduction In contrast to familiar developmental anomalies,such as pancreatobiliary maljunction and pancreas divisum,a double orifice of the ampulla of vater is a much more rare congenital malformation.We encountered a patient with pancreatolithiasis associated with anatomic variation of Wirsung duct showing a single major duodenal papilla with a double orifice and no minor papilla.

关键词： vater orifice congenital

Signet Ring Cell Carcinoma of Ampulla of vater: Report of a Rare Malignancy and Literature Review

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Case Reports in Clinical Medicine 2014年第3期3卷 145-148页

作者： Ihsane Souaf Kawtar Znati Sanae Chahbouni Imane Hafid Hassania Ameurtesse Nawale Hammas Leila Chbani Hinde El Fatemi Tawfik Harmouch Afaf Amarti Department of Pathology Hassan II University Hospital of Fez Hassan Morocco

Introduction: Signet ring cell carcinoma is a rare tumor that generally originates in the gastrointestinal tract. Signet-ring cell carcinoma of the ampulla of vater is extremely uncommon and a very rare clinical entity, which is infrequently reported in medical literature and only 31 cases have been mentioned. Most tumors affecting vater’s Ampulla are adenocarcinomas and other histological variants are less frequent. It mainly occurs in elderly patients. Case Presentation: We report a case of signet ring cell carcinoma of vater’s Ampulla. The tumour had infiltrated the duodenal, but local lymph nodes were clear (T3N0M0). Duodenopancreatectomy with pylorus preservation is the treatment of choice. Conclusions: Etiology and survival are not well-defined in the literature due to the extreme rarity of this disease.

关键词： Ampulla of vater Carcinoma Signet Ring Cell Pancreas

Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature

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World Journal of Clinical Cases 2019年第6期7卷 717-726页

作者： Feng Liu Jia-Lin Cheng Jing Cui Zong-Zhen Xu Zhen Fu Ju Liu Hu Tian Department of General Surgery Shandong Provincial Qianfoshan HospitalShandong University Taishan Medical University Department of Pathology Shandong Provincial Qianfoshan HospitalShandong University Medical Research Center Shandong Provincial Qianfoshan HospitalShandong University

BACKGROUND Transduodenal ampullectomy(TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However,TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors,precancerous lesions,and benign and malignant borderline tumors,and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.AIM To investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.METHODS Ten patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions,and the endoscopic ultrasound(EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy,intraoperative frozen-section pathological examination,and postoperative pathological examination.RESULTSThis study included seven patients with benign tumors and three with malignant tumors(1 pTis,2 pT1),according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100%(10/10),and the coincidence rate with the endoscopic biopsy results was 70%(7/10) based on pathological characteristics.The endoscopic biopsy false-negative rate was 30%(3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.CONCLUSION The coincidence rate of postoperative pathology results,intraoperative frozensection pathology results,and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.

关键词： Ampulla of vater Ampullary neoplasm Transduodenal ampullectomy Pathological diagnoses