Ampulla of Vater - Revision history

Mitchell: /* Ampullary adenoma */ Added obstruction as a potential mimic of tumor

2017-06-08T15:40:31Z

Ampullary adenoma: Added obstruction as a potential mimic of tumor

← Older revision		Revision as of 15:40, 8 June 2017
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	*[[AKA]] ''tumours of the hepatopancreatic ampulla''.		*[[AKA]] ''tumours of the hepatopancreatic ampulla''.

			==Ampullary Obstruction ==
			[[File:5 890331478 sl 1.png\|Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction]]
			[[File:5 890331478 sl 2.png\|Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction]]
			[[File:5 890331478 sl 3.png\|Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction]]
			[[File:5 890331478 sl 4.png\|Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction]]
			[[File:5 890331478 sl 5.png\|Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction]]<br>
			Villous appearing duodenal mass of ampulla, secondary to ampullary duct obstruction. 43 yo White man. A. Plicae show expansion of stroma by edema with inflammation including neutrophils (neutrophils not shown), by foci of lamina propria hemorrhage (red arrows), and by dilated lymphatics (black arrows). B. A fragment shows dilated ducts on left and center, with connected “proliferating” ducts at right. C. PAS AB stain shows these ducts, by virtue of the thin red line, are ampullary, not Brunner’s glands. D. Nuclei in the proliferated area show striking anisokaryosis and anisonucleosis, as well as hyperchromasia. Note the mitosis (arrow). This notwithstainging, there is an appearance of connection between the ducts. No net appears. Neither are there half glands or aberrant isolated cells. E. On PAS AB stain lay a focus of fibrinopurulent exudate near the proliferating area.
	==Ampullary adenoma==		==Ampullary adenoma==
	===General===		===General===

Mitchell: /* Microscopic */ add a case

2016-12-27T21:41:04Z

Microscopic: add a case

← Older revision		Revision as of 21:41, 27 December 2016
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	#Pancreaticobiliary ampullary carcinoma.		#Pancreaticobiliary ampullary carcinoma.
	#Other.		#Other.
	{\|
	[[File:1 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]		[[File:1 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
	[[File:2 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]		[[File:2 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
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	[[File:5 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]		[[File:5 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
	[[File:6 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]		[[File:6 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
	\|}
	Invasive carcinoma of duodenal ampulla, intestinal type. A. Ulceration tops Brunner’s glands [green arrow]; at the edge lie glands [blue arrow] with changes suggesting adenoma (100X). B. Ki67 stain establishes adenoma by surface extension of brown nuclei (100X). C. The lesion was a mass, prompting rebiopsy. The cauterized fragment shows disorderly spread of glands, with dilated glands at base [arrows] not readily explained by obstruction (40X) D.Two cancerous prongs, one on left [black arrow], one on right [blue arrow] each show spread about muscle fibers (200X). E. The Whipple resection showed the same dilated spreading glands [arrows] at base, redolent of the spread of some well-differentiated colonic adenocarcinomas through muscle (40X). F. Cribriformed cancerous nests [arrows] cannot be Brunner’s glands, because the nuclei are too variable and lack polarity and because they abut crypts extending to the surface; cautery would have made this an impossible distinction (200X).		Invasive carcinoma of duodenal ampulla, intestinal type. A. Ulceration tops Brunner’s glands [green arrow]; at the edge lie glands [blue arrow] with changes suggesting adenoma (100X). B. Ki67 stain establishes adenoma by surface extension of brown nuclei (100X). C. The lesion was a mass, prompting rebiopsy. The cauterized fragment shows disorderly spread of glands, with dilated glands at base [arrows] not readily explained by obstruction (40X) D.Two cancerous prongs, one on left [black arrow], one on right [blue arrow] each show spread about muscle fibers (200X). E. The Whipple resection showed the same dilated spreading glands [arrows] at base, redolent of the spread of some well-differentiated colonic adenocarcinomas through muscle (40X). F. Cribriformed cancerous nests [arrows] cannot be Brunner’s glands, because the nuclei are too variable and lack polarity and because they abut crypts extending to the surface; cautery would have made this an impossible distinction (200X).

			[[File:5 08466787961551 sl 1.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 2.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 3.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 4.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 5.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 6.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]
			[[File:5 08466787961551 sl 7.png\| 60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver]]

			60 year old woman with poorly differentiated ampullary adenocarcinoma and obstructive cholestasis in liver. A. An isolated tumor fragment (black arrow) and two fragments with tumor undermining small intesatinal mucosa (green arrows) are seen. B. Large, ovoid cancer nuclei with abundant grey cytoplasm form sheets with only rare acini (arrow). C. Tumor cells are CK7 positive. D. Tumor cells are CK20 negative. E. Portal triads (black arrows) are expanded, lacking intense inflammation. A septal duct (green arrow) lacks definite onion skinning. F. Proliferated peripheral bile ductules (black arrows) sometimes have neutrophils (white arrow), which should not be interpreted as ascending cholangitis. Next to the artery (red arrow) lies the bile duct (yellow arrow), which has disturbed nuclei, but no neutrophils. Note occasional eosinophils (cyan arrows). G. Hepatocytes with feathery degeneration. Arrows point to dilated cholangioles, one filled with a bile plug.


	Notes:		Notes:

Mitchell: /* Microscopic */ add a case

2016-10-07T15:21:48Z

Microscopic: add a case

← Older revision		Revision as of 15:21, 7 October 2016
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	#Pancreaticobiliary ampullary carcinoma.		#Pancreaticobiliary ampullary carcinoma.
	#Other.		#Other.
			{\|
			[[File:1 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			[[File:2 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			<br>
			[[File:3 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			[[File:4 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			<br>
			[[File:5 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			[[File:6 amp ca 1 680x512px.tif\|Invasive carcinoma of duodenal ampulla.]]
			\|}
			Invasive carcinoma of duodenal ampulla, intestinal type. A. Ulceration tops Brunner’s glands [green arrow]; at the edge lie glands [blue arrow] with changes suggesting adenoma (100X). B. Ki67 stain establishes adenoma by surface extension of brown nuclei (100X). C. The lesion was a mass, prompting rebiopsy. The cauterized fragment shows disorderly spread of glands, with dilated glands at base [arrows] not readily explained by obstruction (40X) D.Two cancerous prongs, one on left [black arrow], one on right [blue arrow] each show spread about muscle fibers (200X). E. The Whipple resection showed the same dilated spreading glands [arrows] at base, redolent of the spread of some well-differentiated colonic adenocarcinomas through muscle (40X). F. Cribriformed cancerous nests [arrows] cannot be Brunner’s glands, because the nuclei are too variable and lack polarity and because they abut crypts extending to the surface; cautery would have made this an impossible distinction (200X).

	Notes:		Notes:

Michael: /* Other */ fix image

2016-06-09T14:51:54Z

Other: fix image

← Older revision		Revision as of 14:51, 9 June 2016
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	*#Mucinous-signet-ring.		*#Mucinous-signet-ring.
	<gallery>		<gallery>
	Image:Ampulla ~~Ampullary ACA~~-2 PA.JPG\|Ampulla Ampullary Adeno Carcinoma -(SKB)		Image:Ampulla AmpullaryACA-2 PA.JPG\|Ampulla Ampullary Adeno Carcinoma -(SKB)
	Image:Ampulla AmpullaryACA-3 PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)		Image:Ampulla AmpullaryACA-3 PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)
	Image:Ampulla AmpullaryACA PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)		Image:Ampulla AmpullaryACA PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)

Michael: /* Acute inflammation */

2016-06-09T14:49:30Z

Acute inflammation

← Older revision		Revision as of 14:49, 9 June 2016
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	==Acute inflammation==		==Acute inflammation==
			===Sign out===
	<pre>		<pre>
	Ampulla of Vater, Biopsy:		Ampulla of Vater, Biopsy:

Michael: +inflam

2016-06-09T14:49:16Z

+inflam

← Older revision		Revision as of 14:49, 9 June 2016
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	The '''ampulla of Vater''', also '''hepatopancreatic ampulla''', is found in the [[duodenum]]. It has a unique histology and is a relatively common site of disease, when duodenal pathology is considered.		The '''ampulla of Vater''', also '''hepatopancreatic ampulla''', is found in the [[duodenum]]. It has a unique histology and is a relatively common site of disease, when duodenal pathology is considered.

	=Normal histology=		=Benign=
			==Normal histology==
	Periampullary:<ref name=pmid23026934/>		Periampullary:<ref name=pmid23026934/>
	*Intestinal epithelium with goblet cells.		*Intestinal epithelium with goblet cells.
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	*+/-Gastric heterotopia - not common.		*+/-Gastric heterotopia - not common.

	==Sign out==		===Sign out===
	<pre>		<pre>
	DUODENAL BULB, BIOPSY:		DUODENAL BULB, BIOPSY:
	- GASTRIC HETEROTOPIA.		- GASTRIC HETEROTOPIA.
	- NEGATIVE FOR MALIGNANCY.		- NEGATIVE FOR MALIGNANCY.
			</pre>

			==Acute inflammation==
			<pre>
			Ampulla of Vater, Biopsy:
			- Small bowel mucosa with foveolar-like glands (in keeping with
			ampulla), reactive epithelial changes and mild acute inflammation.
			- NEGATIVE for dysplasia.
	</pre>		</pre>

Sarah: /* Other */

2015-03-11T09:11:27Z

Other

← Older revision		Revision as of 09:11, 11 March 2015
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	*#Mixed-mucinous.		*#Mixed-mucinous.
	*#Mucinous-signet-ring.		*#Mucinous-signet-ring.
			<gallery>
			Image:Ampulla Ampullary ACA-2 PA.JPG\|Ampulla Ampullary Adeno Carcinoma -(SKB)
			Image:Ampulla AmpullaryACA-3 PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)
			Image:Ampulla AmpullaryACA PA.JPG\|Ampulla Ampullary Adeno Carcinoma - (SKB)
			</gallery>

	===IHC===		===IHC===

Michael: /* Pancreatobiliary ampullary carcinoma */

2015-02-15T06:26:47Z

Pancreatobiliary ampullary carcinoma

← Older revision		Revision as of 06:26, 15 February 2015
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	*Tubular arrangements consisting of cuboidal cells in one or two layers.		*Tubular arrangements consisting of cuboidal cells in one or two layers.
	**Tubules usually spaced; ~1:3 gland-to-stroma ratio.		**Tubules usually spaced; ~1:3 gland-to-stroma ratio.

			=====Images=====
			<gallery>
			Image: Periampullary adenocarcinoma -- low mag.jpg \| PA - low mag. (WC)
			Image: Periampullary adenocarcinoma -- intermed mag.jpg \| PA - intermed. mag. (WC)
			Image: Periampullary adenocarcinoma -- high mag.jpg \| PA - high mag. (WC)
			Image: Periampullary adenocarcinoma - alt -- high mag.jpg \| PA - high mag. (WC)
			</gallery>

	====Other====		====Other====

Michael: /* Ampullary adenoma */ fix sp.

2013-07-05T10:26:59Z

Ampullary adenoma: fix sp.

← Older revision		Revision as of 10:26, 5 July 2013
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	www:		www:
	*[http://ajcp.ascpjournals.org/content/132/4/506/F1.expansion.html Ampullary adenoma (ajcpjournals.org)].<ref name=pmid19762527/>		*[http://ajcp.ascpjournals.org/content/132/4/506/F1.expansion.html Ampullary adenoma (ajcpjournals.org)].<ref name=pmid19762527/>
	*[http://ajcp.ascpjournals.org/content/132/4/506/F2.expansion.html Ampullary adenoma - ~~pitfals~~ (ajcpjournals.org)].<ref name=pmid19762527>{{Cite journal \| last1 = Bellizzi \| first1 = AM. \| last2 = Kahaleh \| first2 = M. \| last3 = Stelow \| first3 = EB. \| title = The assessment of specimens procured by endoscopic ampullectomy. \| journal = Am J Clin Pathol \| volume = 132 \| issue = 4 \| pages = 506-13 \| month = Oct \| year = 2009 \| doi = 10.1309/AJCPUZWJ8WA2IHBG \| PMID = 19762527 }}</ref>		*[http://ajcp.ascpjournals.org/content/132/4/506/F2.expansion.html Ampullary adenoma - pitfalls (ajcpjournals.org)].<ref name=pmid19762527>{{Cite journal \| last1 = Bellizzi \| first1 = AM. \| last2 = Kahaleh \| first2 = M. \| last3 = Stelow \| first3 = EB. \| title = The assessment of specimens procured by endoscopic ampullectomy. \| journal = Am J Clin Pathol \| volume = 132 \| issue = 4 \| pages = 506-13 \| month = Oct \| year = 2009 \| doi = 10.1309/AJCPUZWJ8WA2IHBG \| PMID = 19762527 }}</ref>

	===Sign out===		===Sign out===

Michael: /* Images */ more

2013-07-05T10:26:25Z

Images: more

← Older revision		Revision as of 10:26, 5 July 2013
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	====Images====		====Images====
	www:		www:
	*[http://ajcp.ascpjournals.org/content/132/4/506/F2.expansion.html Ampullary adenoma (ajcpjournals.org)].<ref name=pmid19762527>{{Cite journal \| last1 = Bellizzi \| first1 = AM. \| last2 = Kahaleh \| first2 = M. \| last3 = Stelow \| first3 = EB. \| title = The assessment of specimens procured by endoscopic ampullectomy. \| journal = Am J Clin Pathol \| volume = 132 \| issue = 4 \| pages = 506-13 \| month = Oct \| year = 2009 \| doi = 10.1309/AJCPUZWJ8WA2IHBG \| PMID = 19762527 }}</ref>		*[http://ajcp.ascpjournals.org/content/132/4/506/F1.expansion.html Ampullary adenoma (ajcpjournals.org)].<ref name=pmid19762527/>
			*[http://ajcp.ascpjournals.org/content/132/4/506/F2.expansion.html Ampullary adenoma - pitfals (ajcpjournals.org)].<ref name=pmid19762527>{{Cite journal \| last1 = Bellizzi \| first1 = AM. \| last2 = Kahaleh \| first2 = M. \| last3 = Stelow \| first3 = EB. \| title = The assessment of specimens procured by endoscopic ampullectomy. \| journal = Am J Clin Pathol \| volume = 132 \| issue = 4 \| pages = 506-13 \| month = Oct \| year = 2009 \| doi = 10.1309/AJCPUZWJ8WA2IHBG \| PMID = 19762527 }}</ref>

	===Sign out===		===Sign out===