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WHO Classification of Tumours
Adenocarcinoma pancreatobiliary type
Region of the ampulla of Vater


This tubular invasive adenocarcinoma displays a cell phenotype similar to that of pancreatic ductal or extrahepatic bile duct carcinomas. It is composed of simple or branching glands associated with an abundant desmoplastic stroma. The epithelium consists of a single layer of cuboidal or columnar cells, usually without nuclear pseudostratification
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Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000

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Yoshikawa D, Ojima H, Iwasaki M, Hiraoka N, Kosuge T, Kasai S, Hirohashi S, Shibata T (2008)
Clinicopathological and prognostic significance of EGFR, VEGF, and HER2 expression in cholangiocarcinoma.
Br J Cancer 98: 418-25

. The nuclei are rounder than in intestinal type adenocarcinomas. In general, greater cytological atypia and more mitotic figures are seen in the pancreatobiliary- type adenocarcinoma than the intestinal-type adenocarcinoma. Small solid clusters of neoplastic cells are seen in the less differentiated tumours.

A focal micropapillary pattern occurs in < 5% of pancreatobiliary-type adenocarcinomas

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Khayyata S, Basturk O, Adsay NV (2005)
Invasive micropapillary carcinomas of the ampullo-pancreatobiliary region and their association with tumor-infiltrating neutrophils.
Mod Pathol 18: 1504-11

. This micropapillary pattern is a marker of clinical aggressiveness in other organs such as the breast and urinary bladder, but its significance in ampullary neoplasms is unknown. Occasionally pancreatobiliary-type adenocarcinomas arise in association with intestinal-type adenomas or noninvasive papillary neoplasms. A small number of invasive carcinomas of the ampulla show a mixed intestinal and pancreatobiliary phenotype.

Pancreatobiliary-type adenocarcinomas have a less favourable prognosis than the intestinal-type ampullary adenocarcinomas

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Balachandran P, Sikora SS, Kapoor S, Krishnani N, Kumar A, Saxena R, Kapoor VK (2006)
Long-term survival and recurrence patterns in ampullary cancer.
Pancreas 32: 390-5

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Roh YH, Kim YH, Lee HW, Kim SJ, Roh MS, Jeong JS, Jung GJ (2007)
The clinicopathologic and immunohistochemical characteristics of ampulla of Vater carcinoma: the intestinal type is associated with a better prognosis.
Hepatogastroenterology 54: 1641-4

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Wittekind C, Tannapfel A (2001)
Adenoma of the papilla and ampulla--premalignant lesions?
Langenbecks Arch Surg 386: 172-5

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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010