Ozyigit Buyuktalanci Dilara, Gun Eylul, Dilek Osman Nuri, Dilek Fatma Husniye
Department of Pathology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
Department of Pathology, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GB, United Kingdom.
Ann Diagn Pathol. 2025 Aug;77:152476. doi: 10.1016/j.anndiagpath.2025.152476. Epub 2025 Mar 24.
Ampullary tumors present diagnostic challenges due to the complex anatomical and histological structure of the ampullary region. They can be classified into four types based on location: Periampullary-duodenal, intra-ampullary, ampullary-ductal, and ampullary-NOS (not otherwise specified). Periampullary-duodenal tumors are exophytic, ulcerovegetative, and often intestinal-type adenocarcinomas with frequent lymph node metastasis. Intra-ampullary tumors are polypoid and confined to the ampullary canal. Ampullary-ductal tumors exhibit sclerotic thickening in the bile or pancreatic duct and are typically pancreatobiliary-type adenocarcinomas. Ampullary-NOS includes tumors that do not fit other classifications. This study aimed to classify ampullary tumors by their anatomical localization, compare histopathological features, and assess the prognostic outcomes for each group. A total of 111 ampullary tumors were selected from 229 pancreaticoduodenectomy specimens over 10 years at our hospital. Clinical, imaging, and macroscopic findings were re-evaluated microscopically. Tumors were classified into four anatomical groups, and their histopathological characteristics and prognosis were analyzed. The cohort had a mean age of 62 ± 10.49 years, with 69 (62.2 %) males and 42 (37.8 %) females. The median survival was 28.23 months. Tumor distribution was as follows: 14.4 % intra-ampullary, 25.2 % ampullary-ductal, 10.8 % periampullary-duodenal, and 49.5 % not otherwise specified (NOS). Pancreatobiliary-type adenocarcinoma (p = 0.003), perineural invasion (p < 0.0001), and lymphovascular invasion (p = 0.002) were significantly more frequent in the ampullary-ductal and NOS groups, which were associated with poorer overall survival (p = 0.011). In addition, lymphovascular invasion and surgical margin positivity were identified as independent prognostic markers. Classifying ampullary tumors based on anatomical location is crucial due to significant histopathological and prognostic differences between the groups.
壶腹周围肿瘤由于壶腹区域复杂的解剖和组织学结构而带来诊断挑战。根据位置，它们可分为四种类型：壶腹周围十二指肠型、壶腹内型、壶腹导管型和壶腹未另行指定型（NOS）。壶腹周围十二指肠型肿瘤为外生性、溃疡增殖性，通常是肠型腺癌，常有淋巴结转移。壶腹内型肿瘤为息肉样，局限于壶腹管。壶腹导管型肿瘤在胆管或胰管表现为硬化性增厚，通常是胰胆管型腺癌。壶腹NOS型包括不符合其他分类的肿瘤。本研究旨在根据解剖定位对壶腹周围肿瘤进行分类，比较组织病理学特征，并评估每组的预后结果。在我院10年期间的229例胰十二指肠切除术标本中，共选取了111例壶腹周围肿瘤。对临床、影像学和大体检查结果进行显微镜下重新评估。肿瘤被分为四个解剖学组，并分析其组织病理学特征和预后。该队列的平均年龄为62±10.49岁，男性69例（62.2%），女性42例（37.8%）。中位生存期为28.23个月。肿瘤分布如下：壶腹内型14.4%，壶腹导管型25.2%，壶腹周围十二指肠型10.8%，未另行指定型（NOS）49.5%。胰胆管型腺癌（p = 0.003）、神经周围侵犯（p < 0.0001）和淋巴管侵犯（p = 0.002）在壶腹导管型和NOS组中明显更常见，这与总体生存率较差相关（p = 0.011）。此外，淋巴管侵犯和手术切缘阳性被确定为独立的预后标志物。由于各解剖学组之间存在显著的组织病理学和预后差异，因此基于解剖位置对壶腹周围肿瘤进行分类至关重要。
