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Objective To analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of intestinal-type and pancreaticobiliary-type invasive adenocarcinomas of the ampullary region (IAARs) and investigate the value of the differential diagnosis.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 33 patients with IAAR who were admitted to the Lanzhou University Second Hospital (20 patients) and Affiliated Hospital of Ningbo University (13 patients) between September 2013 and August 2015 were collected.The patients underwent plain and enhanced scans of CT and MRI.(1) Observation indictors included tumor size,shape,growth pattern,boundary,internal structure,density and/or signal,style and/or degree of contrast enhancement,changes of bile and/or pancreatic duct,invasion and metastasis.(2) The clinical and imaging features of intestinal-type and pancreaticobiliary-type IAARs were compared.(3) Operation was performed after preoperative examinations,and patients received the postoperative pathological examination and immunohistochemistry.Measurement data with normal distribution were presented as x-±s.Comparison between groups was evaluated with an independent sample t test,and count data were analyzed using the chi-square test.Results (1) Of 33 patients with IAAR,19 received plain scan of CT,including 17 receiving simultaneous enhanced scan of CT.Fourteen patients [9 receiving diffussion-weighted imaging (DWI) sequence of MRI] received plain scan of MRI,including 12 receiving simultaneous enhanced scan of MRI.The maximum diameter of IAAR in 33 patients was (2.8 ± 1.4)cm.Fourteen tumors were round-like or oval shape and 19 tumors were irregular shape.The intracavity type,extracavity type and mixed type of tumors were detected in 24,6 and 3 patients,respectively.There were clear boundary of tumors in 17 patients and fuzzy boundary of tumors in 16 patients.Tumors of 5 patients had appeared necrotic and/or cystic,no hemorrhage or calcification was found in tumors of 33 patients.Density and signal of tumors were homogeneous in 18 patients and inhomogeneous in 15 patients.Of 29 patients receiving enhanced scan of CT or MRI,homogeneous enhancement and inhomogeneous enhancement were respectively detected in 14 and 15 patients,and mild enhancement,moderate enhancement and no enhancement were respectively detected in 15,14 and 0 patients.Tumors of 9 patients in DWI showed slightly high or high signal.Thirty patients had secondary bile duct dilatation (3 with mild dilatation,6 with moderate dilatation and 21 with severe dilatation),and 3 patients had no changes of bile duct.Twenty-six patients had secondary pancreatic duct dilatation and 7 had no changes of pancreatic duct.Sixteen patients had tumor invasion to pancreatic tissues and 7 had lymph node metastases.(2) Of 33 patients with IAAR,19 had intestinal-type IAAR (8 males and 11 females) and 14 had pancreaticobiliary-type IAAR (11 males and 3 females).There was statistically significant difference in the gender between the 2 types of IAAR (x2=4.388,P ＜ 0.05).The intracavity type,extracavity type and mixed type of tumors,clear boundary and fuzzy boundary of tumors,homogeneous and inhomogeneous density and/or signal of tumors,with and without tumor invasion to pancreatic tissues were respectively detected in 17,0,2,13,6,14,5,6,13 patients with intestinal-type IAAR and 7,6,1,4,10,4,10,10,4 patients with pancreaticobiliary-type IAAR,with statistically significant differences between the 2 types of IAAR (x2=9.971,5.125,6.617,5.125,P ＜ 0.05).(3) All the patients underwent surgery and received comprehensive diagnosis and tumor classification after pathological examination and immunohistochemistry.Conclusion There are certain characteristics of CT and MRI in intestinal-type and pancreaticobiliary-type IAARs,and gender,tumor growth pattern,boundary,density and/or signal,tumor invasion to pancreatic tissues have certain reference values for the differential diagnosis of intestinal-type and pancreaticobiliary-type IAARs.
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Objective To summarize the clinicopathological features of ampullary cancer,and investigate the diagnosis and treatment strategy for ampullary cancer.Methods The clinical data of 187 patients with ampullary cancer who were admitted to the Peking Union Hospital from January 2000 to December 2010 were retrospectively analyzed.According to different surgical procedures applied,patients were divided into pancreaticeduodenectomy (PD) group (162 patients) and local resection group (25 patients).Survival curve was drawn by using Kaplan-Meier method,and the difference in survival rate between the 2 groups was compared by using Log-rank test.All data were analyzed by using t test or chi-square test.Results The positive diagnostic rates of B-ultrasound,computed tomography (CT),magnetic resonance imaging (MRI) and endoscopic retrograde cholangiopancreatography (ERCP) were 9.3％ ( 15/161 ),43.9％ (65/148),21.3％ (19/89) and 83.9％ ( 135/161 ),respectively.There were 87 patients with well differentiated adenocarcinoma,64 with moderate differentiated adenocarcinoma,27 with low differentiated adenocarcinoma and 9 with tubular canceration.There were no significant differences in survival rate between patients with ampullary cancer in T1 or T2 stage who received PD or local resection ( x2 =3.163,P ＞0.05).The prognosis of patients with ampullary cancer in T3 or T4 stage who received PD were superior to those who received local resection ( x2 =6.309,P ＜ 0.05 ).Conclusions Most of the ampullary cancer is well differentiated adenocarcinoma,and ERCP has a higher diagnostic rate than B-ultrasound,CT and MRI.Local resection is an ideal treatment for patients with ampullary cancer in T1 or T2 stage,while for patients with ampullary cancer in T3 or T4 stage,PD is the first choice of treatment.
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Ampullary cancer is a relatively uncommon cancer,which is often considered to have a best prognosis among periampullary cancers.Preoperative endoscopic uhrasonography and transpapillary intraductal ultrasonography Call provide useful information not only for tumor staging but also for making therapeutic decisions,especially in patients who are appropriate for endoscopic papillectomy.Whipple resection and pylrus preserring panereaticoduodenectomy are considered to be the standard treatment for ampullary cancer.Although transduedenal ampullectomy is regarded as a less-invasive treatment compared with Whipple resection,it has a high morbidity and hish rate of cancer-cell remnant at the resected margin.Endoscopic papiilectomy may be the treatment of choice for selected cases of ampullary cancer. As to unresectable ampullary cancer,the performance of a biliary-enteric bypass is considered routine to solve obstructive ianndice.The decision as to whether to perform gastrojejunostomy in patients without obvious gastroduodenal obstruction secondary to the tumor remains controversial.We believe that prophylactic gastrojejunostomy should be performed routinely when a patient is undergoing surgical palliation for unresectable ampullary cancer.
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Purpose:To investigate the expression of VEGF and its prognostic significance in ampullary carcinoma.Methods:22 resected tumor specimens from patients with ampullary carcinoma were immunohistochemically stained for VEGF and CD34 (surrogate for vessels) by streptavidin-peroxidase (S-P) method. Results:Expression of VEGF in tumor tissue was found in 50% cases of patients with ampullary carcinoma. The mean MVD for the entire group was 26.4?12.8. A significantly higher MVD(35.0?9.6) was observed in the tumors with positive VEGF expression compared with tumors with negative VEGF expression(17.7?9.3)( P