Contribution of endoscopy to diagnosis and treatment of tumors of the ampulla of vater
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Abstract:
In a series of 52 patients presenting with tumors of the ampulla of Vater, endoscopic procedures, especially endoscopic sphincterotomy and snare biopsies, permitted histologic classifications as follows: adenocarcinoma: 50%, adenoma: 35%, and adenoma with cancer: 15%. In 37% of cases, the papilla was normal endoscopically and the tumor was detected only after sphincterotomy. Destruction of adenomas by snare resection, laser photoradiation, or both after sphincterotomy was attempted in 11 patients. Subsequent biopsies revealed persistence or recurrence of adenomatous tissue in only one case and complete destruction of adenomas, with a mean duration of follow-up of 39 months, in the 10 other cases. Palliative treatment by endoscopic procedures was performed in 21 patients and was effective for a mean of 45 months for adenomas and for a mean of 6 months for adenocarcinomas, with a mortality of 10%. To avoid repeated sphincterotomy in patients requiring palliative treatment, the data support the early use of endobiliary prostheses. Endoscopic palliative treatment is not indicated, however, for infiltrative tumors that can induce rapid duodenal obstruction.Keywords:
Ampulla of Vater
Major duodenal papilla
Ampulla
Duodenoscopy
This report described a patient who presented with biliary tract obstruction caused by ampullary hamartoma. Duodenoscopy showed a large mass on the ampulla of Vater. Endoscopic biopsy revealed no evidence of malignancy. Frozen section biopsies of the tumor performed during operation disclosed hamartoma without evidence of malignancy. Therefore, simple local excision and sphincteroplasly were performed. The serial histological sections of the resected specimen confirmed a hamartoma of the ampulla of Vater. Hamartomas are unusual tumors in the duodenum; we, therefore, present this very rare case.
Ampulla of Vater
Ampulla
Hamartoma
Duodenoscopy
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The optimal treatment of tumors of Vater's region represents a permanent interest of every physician involved in the treating of malignant diseases with such localization.This presentation proposes a pancreaticoduodenectomy (DPC) evaluation in the surgical treatment of tumors of Vater's ampulla.Between 1999 - 2009 our clinic has treated a number of 37 cases with mechanic jaundice by malignant diseases (JMN). Out of these, 5 cases (13.5%) have been hospitalized with JMN (preoperative diagnose) by malignant tumors of Vater' region: 4 men and a woman, aged 46 to 72, from rural medium, who represent the aim of this paper. RESULTS.In 4 cases (10,.8%), intra-operatory exploration confirms the existence of tumors of Vater's ampulla or duodenal papilla (diagnosis having been established by preoperatory duodenoscopy) using DPC (Child Procedure). Postoperative evolution, either immediate or distanced, was favorable, implying no deaths. The microscopic exam of the extirpated piece confirms Vater's Ampulloma in two cases (5.4%); in the other two cases, the above mentioned exam reveals the small bowel's carcinoma at duodenal papilla. In the last 2.7% cases intra-operatory lymph node and visceral metastases have been observed, choledochoscopy revealing cholangiocarcinoma (confirmed by microscopic exam), the patient having suffered only a choledochoduodenostomy.Without being endowed with great experience in the field, the results of DPC treatment in these first cases of malignant tumors of Vater's region allow us to found the reasoning of the righteousness of surgical indication. DPC draws the hope of radical healing intention in the cancer with this localization.
Major duodenal papilla
Ampulla of Vater
Duodenoscopy
Whipple Procedure
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Case report. We present the case of a 50-year-old female patient with inherited type 1 neurofibromatosis, who was found to have a tumor in the major duodenal papilla. She underwent endoscopic ultrasound-guided resection of the major duodenal papilla with subsequent histological and immunohistochemical examination. Discussion. Somatostatinomas are rare neuroendocrine tumors of the gastrointestinal tract with an annual incidence of 1 case per 40 million people. The combination of type 1neurofibromatosis and somatostatinoma of the ampulla of the major duodenal papilla occurs extremely rarely. Endoscopic ultrasound provides visualization of tumor spread in all layers of the intestinal wall and in the major duodenal papilla, thus giving opportunity to perform radical surgery by minimally invasive method. Conclusions. Minimally invasive endoscopic surgery in patients with a combination of type 1 neurofibromatosis and somatostatinoma is a good alternative to pancreatic resection in this rare category of patients. Further follow-up studies are needed.
Major duodenal papilla
Ampulla
Ampulla of Vater
Endoscopic Ultrasound
Papillary tumor
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The anatomy of the ampullary termination of the bile and pancreatic ducts is complex; appropriate terminology for this area is confusing and inaccurate. We examine the terms "ampulla of Vater" and "papilla of Vater" for anatomical and historical correctness. The term "ampulla" refers to a dilated part of a duct or other channel. Thus, this word is topographically correct to describe the dilatation at the confluence of the bile and main pancreatic ducts; historically, however, there is considerable reason to believe that its first description was by Santorini rather than Vater. The eponymous term "papilla of Vater" is also incorrect historically. The use of eponyms is firmly entrenched in the medical literature, but some are so problematic that they should be discarded. The eponymous terms for both the ampulla and the papilla should be replaced with the terms "hepatopancreatic ampulla" (or "biliaropancreatic ampulla") and "major [or "greater"] duodenal papilla," respectively.
Major duodenal papilla
Ampulla
Ampulla of Vater
Common Duct
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Major duodenal papilla
Ampulla of Vater
Ampulla
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症例は64歳男性.61歳時に閉塞性黄疸で入院した.ERCPを行うも結石認められず,ERBD tube挿入のみで改善した既往歴がある.2005年5月,上腹部痛を主訴に内科を受診した.CTで膵石を伴う膵管拡張,総胆管内の結石を認め,慢性石灰化膵炎急性増悪,総胆管結石の診断で入院となる.内視鏡的に除石を試みるも不可能であり,手術目的に当科紹介となる.術中所見で,膵石の共通管部への嵌頓による閉塞性黄疸と診断され,外科的乳頭切開除石と総胆管切石術に加え膵頭部芯抜きを伴う膵管空腸側々吻合術(Frey手術)を施行し良好な経過を得た. 膵石の乳頭部嵌頓による閉塞性黄疸は極めて稀であるが,慢性石灰化膵炎の場合はこれも念頭に置き,治療に当たる必要がある.
Major duodenal papilla
Ampulla
Ampulla of Vater
Obstructive jaundice
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Duodenoscopy
Ampulla of Vater
Ampulla
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Major duodenal papilla
Ampulla of Vater
Ampulla
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Carcinoma of the ampulla of Vater is closely associated with tubular and villous adenomas of the ampulla. Its prognosis is strongly related to the degree of invasion and nodal involvement. However, the determination of the extent of invasion is not easy. We describe such a case with three-dimensional spread into duodenum and common bile and pancreatic ducts preoperatively detected by hypotonic duodenography, duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography. The histological examination of an endoscopic biopsy specimen revealed only dysplasia. A resected specimen showed carcinoma of Vater's ampulla with three-dimensional spread, but the invasion was limited to the epithelial and mucosal layers.
Ampulla of Vater
Ampulla
Duodenoscopy
Villous adenoma
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Ampulla of Vater
Ampulla
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