Summary
Diverse tumors may arise at the ampulla of Vater, although the clinical manifestations
for all types of lesions are similar. Carcinoma and benign adenomas are the most important
ampullary tumors, and there is evidence that adenomas are premalignant. Endoscopy
offers the best prospect of accurate diagnosis, but the sensitivity and specificity
of this diagnostic modality is less than expected. In particular, endoscopic biopsies
may be falsely negative for carcinoma in a significant percentage of cases. When successful,
EBCP may demonstrate dilated pancreatic and bile ducts and in some cases the presence
of a tumor mass. The preferred treatment for virtually all ampullary tumors is surgery,
the general types of operation being local resection, pancreatoduodenectomy, and biliary
decompression procedures. The choice of operation depends on whether the tumor is
benign or malignant, its extent, especially if malignant, and an assessment of the
patient's ability to withstand radical resection. Although the operative morbidity
and mortality is lower for local excision in comparison to pancreatoduodenectomy,
there is a greater chance for recurrence of malignant and premalignant neoplasms when
the tumor is locally excised.
Key words:
Ampulla of Vater - Tumors - Endoscopy - Surgery
