[Periampullary carcinoma or tumor of the ampulla of Vater?]

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.