Schneider A R J, Seifert H, Trojan J, Stein J, Hoepffner N M
Medical Department I, University Hospital, Frankfurt/Main, Germany.
Z Gastroenterol. 2005 Oct;43(10):1123-7. doi: 10.1055/s-2005-858628.
Epithelial tumors of the papilla of Vater are rare neoplasms of the gastrointestinal tract. The carcinogenesis of these tumors seems to be fairly analogous to the genetic mechanisms which have been described for colorectal carcinoma. Patients with familial adenomatous polyposis bear a particularly increased risk for periampullary tumors. Data on whether the prevalence of colorectal tumors is increased in patients with sporadic ampullary neoplasms are scarce.
26 consecutive patients (16 women, 10 men; median age 59 years) with sporadic adenomas (n = 19) or adenocarcinomas (n = 7) of the ampulla of Vater were retrospectively evaluated. The study patients were compared with 104 age-matched asymptomatic controls. All patients had undergone total colonoscopy.
Neoplastic colorectal polyps were present in a similar proportion (23%) of patients of the study group compared with 26% in the control group (p > 0.05). Overall, 16 polyps were found among patients with ampullary tumors and 40 in asymptomatic controls (p > 0.05). Colonoscopy detected rectal carcinoma in 2 patients (8%) of the study group. Patients with and without colorectal polyps differed neither significantly by age nor by ampullary histological findings. 50% of the colonic polyps in patients with ampullary neoplasms were located in the ascending colon.
The frequency of colorectal polyps in patients with ampullary tumors did not exceed the risk in the control group. However, the finding of 2 rectal carcinomas among patients with ampullary neoplasms supports the place of screening colonoscopy for the diagnostic work-up of ampullary tumors. Prospective multicenter studies should address this issue to provide a broad basis for future recommendations.
壶腹乳头的上皮性肿瘤是胃肠道罕见的肿瘤。这些肿瘤的致癌机制似乎与已描述的结直肠癌的遗传机制相当类似。家族性腺瘤性息肉病患者发生壶腹周围肿瘤的风险特别增加。关于散发性壶腹肿瘤患者结直肠肿瘤的患病率是否增加的数据很少。
回顾性评估26例连续的散发性壶腹腺瘤（n = 19）或腺癌（n = 7）患者（16例女性，10例男性；中位年龄59岁）。将研究患者与104名年龄匹配的无症状对照进行比较。所有患者均接受了全结肠镜检查。
研究组患者中存在肿瘤性结直肠息肉的比例（23%）与对照组的26%相似（p > 0.05）。总体而言，壶腹肿瘤患者中发现16个息肉，无症状对照中发现40个息肉（p > 0.05）。结肠镜检查在研究组的2例患者（8%）中检测到直肠癌。有和没有结直肠息肉的患者在年龄或壶腹组织学发现方面均无显著差异。壶腹肿瘤患者中50%的结肠息肉位于升结肠。
壶腹肿瘤患者中结直肠息肉的发生率未超过对照组的风险。然而，在壶腹肿瘤患者中发现2例直肠癌支持对壶腹肿瘤进行诊断性检查时进行筛查结肠镜检查。前瞻性多中心研究应解决这个问题，为未来的建议提供广泛的基础。
