Site-Specific Subclassification of Ampullary Carcinomas: Delineation of Four Clinicopathologically and Prognostically Distinct Subsets in an Analysis of 249 Cases.
NVolkan Adsay, Nobu Ohike, Takuma Tajiri, Grace E Kim, Alyssa Krasinskas, Serdar Balci, Olca Basturk, Sudeshna Bandyopadhyay, David A Kooby, Shishir K Maithel, Juan Sarmiento, Charles A Staley. Emory, GA; Showa, Yokohama, Japan; UCSF, San Francisco, CA; UPMC, Pittsburgh, PA; MSKCC, NY; WSU, MI
Background: Ampullary (AMP) carcinomas (ACs) encompass a highly heterogeneous group; there have not been uniformly applied definitions or systematic analysis of the neoplasms arising in different compartments of this region.
Design: 249 strictly-defined primary ACs were analyzed with careful correlation of gross and microscopic findings to determine the tumor epicenter, and if present, extent of involvement by preinvasive neoplasm of the duodenal surface (DS), the edge of papilla of Vater (PV) and intraampullary region (IA). Their prognosis was compared to that of 112 pancreatic carcinomas.
Results: I. Overall, AC cases had significantly better prognosis than pancreatic carcinoma cases (p<0.01). II. ACs could be further classified into 4 distinct subtypes (See figure 1 for illustration and clinicopathologic information). 1.AMP-NOS: Ulcero-fungating tumor located at PV with epicenter of invasion at PV/IA was most common (56%). 2.Intra-AMP: Invasive carcinomas arising in intraampullary papillary-tubular neoplasms (AJSP, 2010, in press) had the best prognosis. These relatively large overall sized tumors had smaller size of invasion and typically occurred in men. 3.AMP-ductal: Mucosal-covered, button-like elevation of PV without significant exophytic (preinvasive) growth on DS/PV had plaque-like thickening of intrapancreatic CBD or pancreatic duct walls that formed constructive sclerotic (non-exophytic) tumors. These were the smallest tumors, but had the worst prognosis, presumably due to pancreatobiliary histology/origin, yet prognosis was better than pancreatic carcinomas (p<0.01). 4.PeriAMP-duodenal: Exophytic (ulcero-fungating) duodenal tumor encasing PV but with bulk of preinvasive tumor (>75%) involving DS, and invasion epicenter away from ampulla itself. These were fairly large tumors with intestinal phenotype and high incidence of LN metastases.
Conclusions: AC comprises 4 clinicopathologic subtypes (AMP-NOS, intra-AMP, AMP-ductal and PeriAMP-duodenal) that are prognostically distinct.
Category: Liver & Pancreas
Monday, February 28, 2011 1:15 PM
Platform Session: Section D, Monday Afternoon