Ampulla of Vater
Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 30 November 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
● Mucosa forms prominent papillary folds / reduplications resembling fallopian tubal fimbriae with fibrovascular cores
● Lined by pancreaticobiliary-type ductal epithelium with occasional goblet cells, no absorptive-type cells
● Lamina propria has only occasional lymphocytes, plasma cells and mast cells
● May have adjacent pancreatic acini, but usually no islets around major papillae
● Common bile duct can be distinguished from main pancreatic (Wirsung) duct by its larger size, more prominent folds, thicker musculature, intraluminal bile
● Ampullary biopsy performed in autoimmune pancreatitis can help to differentiate from other “mass forming” pancreatitis by IgG4+ to IgG+ ratio (Am J Surg Pathol 2008;32:1770)
End of Ampulla of Vater > Benign/non-neoplastic > Normal histology
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