Assessment of ampulla of Vater pathology. An endoscopic approach.

One hundred eighty-nine endoscopic biopsies of the papilla of Vater were obtained from 125 patients during a 10-year period. Chronic inflammation was the most common histologic change identified. Of the 44 patients with papillary neoplasia, 42 were diagnosed by endoscopic biopsy. Sixteen of the 18 patients with invasive carcinoma were diagnosed by biopsy. Follow-up biopsies in patients endoscopically managed demonstrated recurrent tumors in 6 of 11 patients. With advances in instrumentation and techniques, pathologists can expect to see increasing numbers of ampullary biopsies. When multiple biopsy fragments are obtained and step sectioned, the diagnostic reliability of endoscopic biopsies in patients with tumors and carcinoma is greater than 90%. The morphologic spectrum of papillary lesions is similar to that seen in the colon with some significant exceptions. Tumor morphology varied considerably from area to area. Variations were seen in the basic architecture (villous-tubular), grade of dysplasia, presence of malignancy, and invasion from fragment to fragment, and in some cases from microscopic field to field. Another notable difference between the ampulla and colon is the rich mucosal lymphatic network of the ampullary region. Thus, any carcinoma invading the lamina propria was diagnosed as invasive carcinoma.