Ampulla of Vater
Premalignant / noninvasive

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 22 January 2016, last major update December 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Adenoma[title]
Cite this page: Adenoma. website. Accessed July 17th, 2018.
Definition / general
  • Similar histologically to colonic adenoma
  • Increased incidence in familial adenomatous polyposis syndrome
  • Excellent prognosis if completely excised
  • Polypectomy or pancreatoduodenectomy since premalignant
Microscopic (histologic) description
  • Tubular, villous or mixed, similar to adenomas in colon, although:
    (a) Dysplastic epithelium may have only subtle changes of mild cellular stratification and fine chromatin pattern
    (b) Often contain prominent Paneth cells (with coarse, large, red-pink, refractile granules in supranuclear cytoplasm), endocrine cells (dark, red-purple, fine small granules in basal cytoplasm) and goblet cells
  • Associated with high grade PanIN in 40% of cases, similar rate as adenocarcinomas
Microscopic (histologic) images

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Intestinal type adenoma

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Tubular adenoma with mild dysplasia

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Villous adenoma

Cytology description
  • Endoscopic brush cytology is sensitive and specific for adenoma /carcinoma, although diagnosis of adenoma does not exclude coexisting carcinoma (Am J Clin Pathol 1998;109:540)
Molecular / cytogenetics description
  • Sporadic and FAP-related adenoma show similar molecular features to colorectal adenoma, with presence of APC and KRAS mutations
  • BRAF mutations, p53 alterations, and DNA mismatch repair abnormalities are rare (Am J Surg Pathol 2008;32:1388)
Differential diagnosis
  • IPMN of pancreas or common bile duct adenoma extending into ampulla
Additional references