Small intestine & ampulla

Ampulla

Adenoma


Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Last author update: 11 January 2021
Last staff update: 2 August 2023

Copyright: 2003-2024, PathologyOutlines.com, Inc.

PubMed Search: Adenoma ampulla

Raul S. Gonzalez, M.D.
Page views in 2023: 20,679
Page views in 2024 to date: 4,944
Cite this page: Gonzalez RS. Adenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ampullaadenoma.html. Accessed March 19th, 2024.
Definition / general
  • Dysplastic, premalignant lesion of ampulla of Vater
Essential features
ICD coding
  • ICD-10: D37.6 - Neoplasm of uncertain behavior of ampulla of Vater
Epidemiology
Clinical features
  • Usually asymptomatic but can cause gastric outlet obstruction or bleeding and rarely acute pancreatitis, biliary obstruction or intussusception
  • Excellent prognosis if completely excisedโ€จ
  • Often associated with concurrent pancreatic intraepithelial neoplasia (Mod Pathol 2001;14:139)
Diagnosis
  • Endoscopic impression, confirmed on biopsy
Case reports
Treatment
  • Early or relatively confined lesions may be excised by endoscopic polypectomy or ampullectomy (Am J Clin Pathol 2009;132:506)
  • Otherwise, requires pancreatoduodenectomy
Clinical images

Images hosted on other servers:

Endoscopy

Gross description
  • Polypoid / exophytic mass
Gross images

Images hosted on other servers:

Raised lesion at ampulla of Vater

Microscopic (histologic) description
  • Tubular, villous or mixed, similar to adenomas in colon, with approximately half tubular and half villous (Am J Clin Pathol 2009;132:506)
  • Dysplastic epithelium may have only subtle changes of mild cellular stratification and fine chromatin pattern
  • 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
  • May show high grade dysplasia or give rise to adenocarcinoma
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D. and @Andrew_Fltv on Twitter

Ampullary adenoma with low grade dysplasia

Adenoma Adenoma

Adenoma



Images hosted on other servers:

Ampullary adenoma with high grade dysplasia

Ampullary 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)
Cytology images

Images hosted on other servers:

Pap

Molecular / cytogenetics description
Sample pathology report
  • Ampulla, polypectomy:
    • Ampullary adenoma (low grade dysplasia)
Differential diagnosis
Board review style question #1
Which of the following is true about adenomas of the ampulla of Vater?

  1. BRAF mutations are rarely seen
  2. Cases must be managed with pancreatoduodenectomy
  3. Patients with Lynch syndrome are at significantly increased risk
  4. Progression to adenocarcinoma is unusual
Board review style answer #1
A. BRAF mutations are rarely seen. KRAS and APC mutations are more common, both in sporadic cases and in those from patients with familial adenomatous polyposis.

Comment Here

Reference: Adenoma
Board review style question #2
A polypoid lesion of the ampulla is biopsied and shows the features below. Which of the following molecular mutations is most likely to be present?



  1. BRAF
  2. KRAS
  3. MLH1
  4. STK11
Board review style answer #2
B. KRAS mutations are most commonly seen in ampullary adenomas, along with APC mutations.

Comment Here

Reference: Adenoma
Back to top
Image 01 Image 02