ERCP is important and useful method in the diagnosis of ampulla Vater tumors, but endoscopic histologic diagnosis is often difficult in nonexposed ampullary tumor and adenoma with cancer focus. The objectives of this study are to assess clinical
characteristics, endoscopic gross morphology, histology, and fluoroscopic findings of 30 cases of ampulla Vater tumor. They are 15males and 15 females, ranging in age from 28 to 77 years. Chief complaint was jaundice in 25 cases (85%), other
complaints
were epigastralgia, fever, weight loss, anorexia in order. 5 cases (17%) were associatd with other diseases, 4 cases were biliary stones and 1 case was diagnosed by endoscopy in check up of recurrent panceretitis with dilated common bile duct in
abdominal CT. Endoscopic gross findings showed non exposed polypoid type in 2 cases (6%), most common exposed polypoid type in 17 cases(57%), mixed type in 10 cases(34%) and ulcerative type in only 1 cases(3%). Endoscopic biopsy was done in all
30
patients, in 2 cases of non exposed polypoid tumor, the papilla mucosa endoscopically and forcep biopsy was done only after sphincterotomy, and in the remaining 28 cases, forcep biopsy was done without the aid of sphincterotomy. Endoscopic biopsy
revealed adenocarcinoma in 27 cases (90%), adenoma in 2 cases (7%), malignant lymphoma in 1 cases (3%). ERC was succeed 28 patients and ERP was succeed in 13 parients. ERC findings showed common bile duct dilatation in all 28 patients, distal
common
bile duct stricture in 13 cases(46%), distal common bile duct cutting in 15 cases (54%) and mural or marginal irregularity associated with distal common bile duct cutting in 15 cases (54%) and mural or marginal irregularity associated with distal
common
bile duct stricture or cutting in 11 cases (39%). ERP findings showed main pancreatic duct dilatation in 7 cases(54%), pancreatic duct stricture in ampullary region in 2 cases (15%) and no abnormality in remaining 4 cases (30%). 24 patients
underwent
pancreatoduodenectomy and 5 patients underwent palliative bypass or stent insertion because of distant metastasis or ischemic heart disease, remaining malignant lymphoma patient underwent chemotherapy. Compared with forcep biopsy results and
postoperative pathology, we found adenomatous residues in 3 surgical specimens of ampullary carcinoma (12%), suggesting adenoma-carcinoma sequence, adenoma focus was found in 2 cases of adenocarcinoma and adenocarcinoma focus was found in 1 cases
of
adenoma diagnosed by endoscopic biopsy, this was false negative case with endoscopic biopsy. Compared with macroscopic appearance and extent of tumor invasion, the extent of tumor invasion was not correlated with macroscopic appearance of
ampullary
carcinoma. Final histologic diagnosis of 30 patients were adenocarcinoma in 25 cases (83%), adenocarcinoma with adenoma focus in 2 cases (7%), adenoma with adenocarcinoma focus in 1 cases (3%), adenoma in 1 cases (3%), malignant lymphoma in 1
cases
(3%). These results suggest that the endoscopic biopsy with or without sphincterotomy is very useful in the histologic diagnosis of ampulla Vater tumor even on non exposed tumor, but the correct diagnosis is sometimes difficult even on biopsy for
benign
or malignant character. ERCP is also very useful in the correct diagnosis of ampulla Vater tumor between periampullary tumor or other benign disease such as biliary stone or stricture. (Korean J Gastroenterology 1994 ; 26 : 305-215)
|