Vasilescu C, Herlea V, Stoicescu M
Chirurgia (Bucur). 2000 Sep-Oct;95(5):401-6.
The term periampullary carcinoma is widespread in the medical literature. This is a consequence of the difficulty to establish the histogenesis of the tumor. The question is open if the tissular origin of the mass can be established after an accurate pathological examination and if the effort to distinguish between the so called "periampullary tumors" originating in the pancreatic tissue and those of a biliary, ampullary, duodenal or papillary origin can be useful; if there are significant differences among clinical signs, surgical approach and prognosis of these two sub-classes of "periampullary carcinomas". Between 1990 and 1998 54 patients were operated with the operative diagnosis of periampullary carcinoma in our department. In 35 cases a resection was performed. This 35 operative specimens were retrospectively analysed (operative protocols, macroscopical description of the resected specimens, reevaluation of the slides and new sections from the parafin blocks). Same macroscopic pathological features of the tumors were taken into consideration as suggestive for the pancreatic origin as the concentric development. On the contrary, the infiltrative and exofitic aspects were considered signs for a biliary respectively duodenal origin. The microscopic examination showed 32 adenocarcinoma and 3 undifferentiated carcinomas. In 9 cases a squamous metaplasia, in 22 cases the microscopic invasion of the duodenal wall and in 8 the invasion of the pancreas tissue were present. In 6 cases we found lymph nodes metastasis. The ductal pattern and the squamous metaplasia are suggestive for a pancreatic histogenesis. The papillary proliferation is more characteristic for a biliary or a duodenal origin. After this retrospective analysis we were able to establish the histologic origin of the tumor as follows: 11 with biliary origin, 10 with pancreatic origin and in 14 cases the diagnosis remains "periampullary carcinoma". The term periampullary carcinoma is not a well defined pathological entity. It seems to be an expression of the impossibility to define more accurate the origin of these tumors. Until now, the term remains still useful. However it is reasonable and useful to make the effort to limit such an imprecise diagnosis and to specify the pancreatic, biliary or duodenal histogenesis of the tumor. According to our data as well as to other authors, this accuracy is beneficial for the therapeutic strategy.
壶腹周围癌这一术语在医学文献中广泛使用。这是由于难以确定肿瘤的组织发生学。如果在准确的病理检查后能够确定肿块的组织起源，以及区分源自胰腺组织的所谓“壶腹周围肿瘤”与源自胆管、壶腹、十二指肠或乳头的肿瘤是否有用；这两类“壶腹周围癌”在临床体征、手术方式和预后方面是否存在显著差异，这些问题尚无定论。1990年至1998年间，我院有54例患者接受了手术，术中诊断为壶腹周围癌。其中35例行切除术。对这35份手术标本进行了回顾性分析（手术记录、切除标本的宏观描述、玻片重新评估以及石蜡块新切片）。肿瘤相同的宏观病理特征，如同心圆状生长，被视为提示胰腺起源。相反，浸润性和外生性表现分别被视为胆管和十二指肠起源的征象。显微镜检查显示32例腺癌和3例未分化癌。9例有鳞状化生，22例有十二指肠壁的显微镜下侵犯，8例有胰腺组织侵犯。6例发现有淋巴结转移。导管模式和鳞状化生提示胰腺组织发生。乳头状增生更具胆管或十二指肠起源的特征。经过这项回顾性分析，我们能够确定肿瘤的组织学起源如下：11例为胆管起源，10例为胰腺起源，14例诊断仍为“壶腹周围癌”。壶腹周围癌这一术语并非一个定义明确的病理实体。它似乎是无法更准确界定这些肿瘤起源的一种表述。到目前为止，该术语仍然有用。然而，努力限制这种不精确的诊断并明确肿瘤的胰腺、胆管或十二指肠组织发生是合理且有用的。根据我们的数据以及其他作者的数据，这种精确性对治疗策略有益。
