A Clinicopathological Exploration of Ampullary Adenocarcinoma

Ampullary adenocarcinoma, classified by site-specific and histologic subtypes, lacks comprehensive studies. This study aims to update the clinicopathological features of ampullary adenocarcinoma, focusing on these classifications.

We conducted a retrospective analysis of primary malignant tumors at the papilla of Vater (2002-2022) in our facility. Invasive adenocarcinoma cases were subclassified into intra-ampullary papillary-tubular neoplasm (IAPN)-associated carcinoma, ampullary-ductal carcinoma, periampullary-ductal carcinoma, and ampullary-not otherwise specified (NOS) carcinoma. Additionally, a cell-lineage classification divided cases into intestinal type and gastric/pancreatobiliary type.

Among 63 cases of primary malignant tumors, 54 were invasive adenocarcinoma: 6 (Periampullary-duodenal carcinoma), 14 (IAPN-associated carcinoma), 21 (Ampullary-ductal carcinoma), and 13 (Ampullary-NOS carcinoma). IAPN-associated and Periampullary-duodenal carcinomas had lower pT stages and less lymph node metastasis compared to Ampullary-ductal carcinoma. Lymphovascular invasion and perineural invasion were more prevalent in Ampullary-ductal carcinoma. Tumor size was larger in Periampullary-duodenal carcinoma, while well-differentiated tumors were more common in IAPN-associated and Periampullary-duodenal carcinomas. Intestinal type was more frequent in IAPN-associated and Periampullary-duodenal carcinomas. Gastric/pancreatobiliary types had higher pT stages, more lymph node metastasis, and greater lymphovascular invasion. Although the intestinal type showed a trend toward better prognosis, the differences were not statistically significant.

This study highlights the distinct clinicopathological features of ampullary adenocarcinoma based on site-specific and cell-lineage classifications. Future large-scale studies are needed for better patient stratification and management.