Brush cytology of the papilla of Vater

In every case of duodenal endoscopy we collect cell material from the papilla of Vater by means of a guided brush technique. The microscopic techniques used include phase contrast study of unfixed material and Papanicolaou stained smears. Normal epithelial cells of the papillary region differ from those of the duodenal epithelium and the epithelial cells of the common bile or pancreatic ducts collected by retrograde cannulation. A striking feature in the cytology of the papilla is the marked tendency for cellular atypias. Mostly these atypias have no correlation to histologic biopsy specimens although they persist in such cases during repeated examinations. Tumour cells from carcinoma of the papilla are found very regularly and consequently the cytodiagnosis of these tumours became of great practical value. Polypoid lesions of the papilla give also, a characteristic cell picture. From a cytological point of view the papillary region, where different kinds of epithelia come together, is of special pathogenetic importance.