Learning objectives
-To describe the radiographic findings of periampullary tumors with CT,
ultrasound and MRI.
-To set differential diagnosis between other neoplastic,
inflammatory or litiasic disease that we can find in periampullary region.
Background
The ampulla of Vater comprises the junction of the biliary and pancreatic ducts and is surrounded by the sphincter of Oddi,
the latter is a smooth muscle structure 1 cm long.
The distal constricted end of the ampulla opens into the posteromedial aspect of the duodenum,
falling into major duodenal papilla (Fig 1,
Fig 2).
The junction of the common bile duct and the main pancreatic duct may occur in three ways,
in decreasing order of frequency:
- A common duct
- A single papilla...
Imaging findings OR Procedure details
Ampullary Carcinoma
It represents around a 4% of periampullary tumours.
It grows from the glandular epithelium of the ampulla and it is currently considered as a duodenal cancer.
It is more frequent in the male sex,
60-70 y.o.
Usually,
the tumour is small at the moment of the diagnosis because of the early obstructive symptoms (Fig 3).
Pancreatic carcinoma
80% of cases are localized in the head.
Ductal adenocarcinoma is the most frequent histologic group (85%).
Despite small size at the moment of the diagnosis,...
Conclusion
Periampullar area represents,
from an anatomic point of view,
a complex region.
The proximity of the structures closely related in function and sharing aspects as the blood supply and lymphatic drainage,
allow diseases that affect it have clinical manifestations,
differential diagnosis and similar treatments.
Ultrasonography,
CT-scan and MRI are essential techniques in order to characterize a periampullar tumour and realise a pre-surgical staging.
References
-Kim JH,
Kim MJ,
Chung JJ,
Lee WJ,
Yoo HS TL J.
Differential Diagnosis of Periampullary Carcinomas at MR imaging.
Radiographics.
2002; 22:1335-52.
- Pham DT,
Hura SA,
Willmann JK,
Nino-Murcia M,
Jeffrey RB.
Evaluation of periampullary Pathology with CT Volumentric Oblique Coronal Reformations.
AJR.
2009; 193:202-8.
-Periampullary Tumors: High-Spatial-Resolution MR Imaging and Histopathologic Findings in Ampullary Region Specimens.
Radiology.
2004; 231:767-74.
- Kim S,
Lee NK,
Lee JW,
Kim CW,
Lee SH,
Kim GH,
et al.
CT Evaluation of the Bulging Papilla with Endoscopic...