Approaches to Biopsy and Resection Specimens from the Ampulla

Surg Pathol Clin. 2020 Sep;13(3):453-467. doi: 10.1016/j.path.2020.05.005. Epub 2020 Jul 15.


The ampulla of Vater gives rise to a versatile group of cancers of mixed/hybrid histologic phenotype. Ampullary carcinomas (ACs) are most frequently intestinal or pancreatobiliary adenocarcinomas but other subtypes, such as medullary, mucinous, or signet ring/poorly cohesive cell carcinoma, may be encountered. Ampullary cancer can also be subclassified based on immunohistochemical features, however these classification systems fail to show robust prognostic reliability. More recently, the molecular landscape of AC has been uncovered, and has been shown to have prognostic and predictive significance. In this article, the site-specific, histologic, and genetic characteristics of ampullary carcinoma and its precursor lesions are discussed.

Keywords: Ampulla; Ampullary; Ampullary carcinoma; Duodenal adenoma; IAPN; Intra-ampullary papillary-tubular neoplasm.

Publication types

  • Review

MeSH terms

  • Ampulla of Vater / pathology*
  • Ampulla of Vater / surgery
  • Biopsy
  • Common Bile Duct Diseases / diagnosis
  • Common Bile Duct Diseases / pathology
  • Common Bile Duct Diseases / surgery
  • Common Bile Duct Neoplasms / diagnosis
  • Common Bile Duct Neoplasms / pathology
  • Common Bile Duct Neoplasms / surgery
  • Diagnosis, Differential
  • Humans
  • Neoplasm Staging