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Ampulla of Vater

Premalignant / noninvasive

Adenoma


Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 11 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Similar histologically to colonic adenoma
● Increased incidence in familial adenomatous polyposis syndrome
● Excellent prognosis if completely excised

Treatment
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● Polypectomy or pancreatoduodenectomy since premalignant

Micro description
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● 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

Micro images
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Tubular adenoma with mild dysplasia


Villous adenoma


Intestinal type adenoma

Cytology description
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● 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 description
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● 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
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IPMN of pancreas or common bile duct adenoma extending into ampulla

Additional references
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Am J Clin Pathol 2009;132:506

End of Ampulla of Vater > Premalignant / noninvasive > Adenoma


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