OBJECTIVETo investigate the prognostic implication of common bile duct infiltration in the adenocarcinoma of the ampulla of Vater after panreaticoduodenectomy.

METHODSA retrospective study was conducted on clinical manifestation, pathological behavior and survival data in 102 patients with Vater's ampulla adenocarcinoma, who underwent pancreaticoduodenectomy from Jan 1980 to Dec 2003. The result of patients with the common bile duct infiltration were compared with that of those without.

RESULTSThere were 42 cases in stage I (41.2%), 32 in stage II (31.3%), 27 in stage III (26.5%), and 1 in stage IV (1.0%). As for T stage: 9 cases in stage T1 (8.8%), 40 in T2 (39.2%), 25 in T3 (24.5%), and 28 in T4 (27.5%). As regarding to N stage: 76 cases in stage N0 (74.5%) and 26 in N1 (25.5%). Of these 102 cases, microscopic infiltration in the common bile duct (25.0%) was identified in 26 cases. A significant difference was observed between the patients with bile duct infiltration and those without, in the proportion of pancreatic medullae infiltration: 84.6% (infiltration group) versus 34.2% (non-infiltration group, P < 0.001). Twenty-five cases (24.5%) had recurrence and/or metastases postoperatively, with a median survival of 20 months (range, 2 to 93 months). The overall median survival of the whole group was 46.0 months (2 approximately 192 months), with a significant difference between the common bile duct infiltration group (36 months) and the non-infiltration group (49 months, P = 0.0061). The median non-recurrence survival of the whole group was 43 months (2 approximately 192 months), and a significant difference was observed between the common bile duct infiltration group (35 months) and non-infiltration group (47 months, P = 0.0002).

CONCLUSIONIf the adenocarcinoma of the Vater's ampulla infiltrated the common bile duct, the invasion to the pancreatic medulla is likely developed, and usually with a poor non-recurrence and overall survival. Therefore, postoperative chemotherapy/radiotherapy is suggested.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Ampulla of Vater ; Common Bile Duct ; pathology ; Common Bile Duct Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms ; secondary ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; Pancreaticoduodenectomy ; Retrospective Studies ; Survival Rate

Small cell carcinoma is usually seen in the lung, but rarely involves the gastrointestinal tract including biliary tract. A 65 year-old man was admitted because of obstructive jaundice. A smooth-surfaced round intraluminal mass with proximal bile duct dilatation was seen in the proximal common bile duct on endoscopic retrograde cholangiogram. Under the diagnosis of bile duct cancer, pylorus-preserving pancreatoduodenectomy was done. Pathology revealed a 2 cm sized small cell carcinoma in the proximal common bile duct and distal common hepatic duct. On immunohistochemical stain, the tumor cells were positive for neuroendocrine markers CD56 and synaptophysin. After surgery, the patient received 5 cycles of adjuvant chemotherapy with VIP (etoposide, ifosfamide, and cisplatin) regimen. However, the patient died of liver metastasis 12 months after the diagnosis. We report a case of extrapulmonary small cell carcinoma arising from the common bile duct.
Aged ; Bile Duct Neoplasms/complications/*diagnosis/surgery ; Carcinoma, Small Cell/complications/*diagnosis/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; *Common Bile Duct/radiography/radionuclide imaging/surgery ; Fatal Outcome ; Humans ; Liver Neoplasms/diagnosis/secondary ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

After curative resection of carcinoma of ampulla of Vater, 5-year survival rate has been reported ranging from 40% to 60%. Two major causes of the treatment failure are local recurrence and liver metastasis. Liver metastases are often multiple and are associated with poor prognosis. There have been few reports on long-term survivors after hepatectomy for metastatic liver tumors from carcinoma of ampulla of Vater. We report a 42 year-old female patient with solitary hepatic metastasis from carcinoma of ampulla of Vater, which was successfully treated by hepatectomy 69 months after curative Whipple's operation. Histologic examination of the resected specimen had revealed stage IB moderately-differentiated, intestinal type adenocarcinoma (T2N0M0). Since neither local recurrence or distant metastasis were detected, the patient underwent liver segmentectomy. Histologic study confirmed the presence of metastatic liver tumor from carcinoma of ampulla of Vater. She is doing well without evidence of recurrence at 20 months after hepatectomy.
Adult ; *Ampulla of Vater ; Carcinoma/*diagnosis/secondary/*surgery ; Common Bile Duct Neoplasms/diagnosis/*pathology/surgery ; Female ; *Hepatectomy ; Humans ; Liver Neoplasms/*diagnosis/secondary/*surgery ; Pancreaticoduodenectomy ; Positron-Emission Tomography ; Tomography, X-Ray Computed

OBJECTIVETo identify prognostic factors predicting survival after radical resection of ampullary carcinoma.

METHODSClinical data of sixty- five patients with cancer of the ampulla of Vater underwent pancreaticoduodenectomy and regional lymphadenectomy were analyzed retrospectively.

RESULTSA total of 1380 lymph nodes dissected from the resected specimens was examined to detect the presence of metastasis. The median follow- up period was 83 months. Univariate analysis revealed that factors associated with poor survival included the number and the location of positive nodes. Thirty- three of the 65 patients had a total of 116 positive lymph nodes, of whom 20 had 1- 3 positive regional nodes lymph and 13 had > or = 4 positive regional lymph nodes. Multivariate analysis revealed that the number of positive nodes lymph was an independent prognostic factor (P=0.007), while the locations of lymph nodes failed to remain as an independent variable. The survival rate in patients with > or = 4 positive lymph nodes was significantly lower than that in those with 1- 3 positive lymph nodes. The median survival time was 49 months with a 5- year survival rate of 43% in patients with 1- 3 positive lymph nodes, whereas all patients with > or = 4 positive nodes died of the disease within 23 months after resection (P=0.0001).

CONCLUSIONThe number of positive regional lymph nodes is an independent prognostic factor in patients with ampullary carcinoma after resection.

Adult ; Aged ; Ampulla of Vater ; pathology ; Carcinoma ; pathology ; Common Bile Duct Neoplasms ; pathology ; Duodenal Neoplasms ; diagnosis ; secondary ; Female ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Postoperative Period ; Prognosis ; Retrospective Studies

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Brain Neoplasms/radiography/secondary ; Bronchoscopy ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/*diagnosis/secondary ; DNA-Binding Proteins/metabolism ; Humans ; Immunohistochemistry ; Jaundice, Obstructive/*etiology ; Lung Neoplasms/*diagnosis/pathology/radiography ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed