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Copyright ©Carol Davila University Press This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Introduction: Ampulla of Vater tumors, neoplastic diseases located at the confluence of the common bile duct with the main pancreatic duct; represent 0.

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Method: Retrospective study of all patients admitted in the Emergency Hospital of Bucharest Romania between January and Januarythe only selection criterion used being a pathology report which describes an ampulla of Vater carcinoma. Results: Forty eight patients with ampulla of Vater carcinoma were identified, of whom All patients were evaluated with abdominal transparietal ultrasonography and double contrast, pancreatic protocol, Mutidetector Row Computed Tomography.

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The abdominal Magnetic Resonance Imaging was performed in 10 cases, upper gastrointestinal endoscopy in 9 cases, and Endoscopic Retrograde Cholangiopancreatography in 39 cases. The therapeutic approach was surgical for 44 patients and an endoscopic palliation with stent insertion in 4 cases.

The surgical procedure was represented by Whipple pancreatoduodenectomy in 27 cases, pylorus preserving pancreatoduodenectomy cancer colon pain 15 cases cancer colon pain exploratory laparotomy in 2 cases. Early morbidity was represented by pancreatic leakage in 4 cases.

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Conclusions: There are clinical scenarios in which it is quite challenging to distinguish a primary ampullary adenocarcinoma based on a preoperative workup. Nevertheless, cancer colon pain aggressive approach should be performed, knowing the higher resectability rates and a five-year survival for these patients.

Complete surgical resection should be performed in all medically fit patients, candidates for pancreatoduodenectomy, by a high volume, trained surgeon, able to offer a low morbidity and mortality.

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Keywords: ampulla of Vater, cancer, therapy Introduction Periampullary tumors are neoplastic diseases, benign and malign, arising around the confluence of the common bile duct with the main pancreatic duct, named the ampulla of Vater. The clinical picture is dominated by an early occurrence of jaundice, contributing to the early detection and a higher resection rate. In patients with familial adenomatous polyposis, the papilla of Vater carcinoma is the main location for malignant occurrence after proctocolectomy [ 4 ].

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Henson et al. The authors conclude that these cancers have a common embryonic cellular ancestry, differentiation pathways, mucosal histologic patterns and population-related tumor development indicating a field effect in carcinogenesis. The rate of cancer development is similar in all four cancer colon pain, even though the absolute incidence rate varies. Irrespective of the location, the ductal epithelium has the same malignant transformation rate, the only difference being determined by the relative surface area of the mucosa.

Therefore, in the periampullary region pancreatic head cancers are prevalent due to pancreatic ductal mucosa which has a greater surface area [ 6 ].

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The macroscopic appearance of the ampullary carcinomas may be: a intramural tumors — inside the ampulla, without any protrusion inside the duodenum, b extramural tumors — polypoid tumors protruding through the ampullary orifice cancer colon pain the duodenum, c ulcerative cancers of the ampulla [ 7 ]. Kayahara et al. According to the microscopic classification, there are two main histologic types of carcinoma of the papilla of Vater: a intestinal type — similar to tubular carcinoma of the stomach or the colon, b pancreatobiliary type — characterized by papillary projections with scant fibrous cores [ 9 ].

For the differentiation between these two types is also useful the immunohistochemical staining for apomucin of the mucosa MUC2 and keratin types CK7 and CK20 [ 10 ].

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According to de Paiva Haddad et al. They have observed a higher expression for MUC2 Abdominal Computed Tomography, strictly adhering to the pancreatic protocol, is very useful for diagnosis and pretherapeutic staging of the periampullary tumors.

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This have to be performed with oral and intravenous contrast material, during one breath-hold, with mm slices performed during arterial and venous contrast enhancement [ 12 ].

Magnetic retrograde colangiopancreatography may offer additional details about papilla of Vater and surrounding structures [ 13 ]. Sugita et al. Transabdominal ultrasonography has a lower sensitivity; meniuri pt detoxifiere example, a study conducted by Qiao et al.

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Skordilis et al. Nowadays, studies investigating the applicability of natural orifice transluminal endoscopic peritoneoscopy for the staging of pancreatic head masses are under investigation, finding a high concordance with laparoscopic exploration for the assessment of peritoneal metastases [ 20 ]. Method For this retrospective study, we have selected all patients admitted in the Emergency Hospital of Bucharest Romania, between January and Januarywith a pathology report describing an ampulla of Vater carcinoma, even if the specimen cancer colon pain obtained after a surgical resection or after an endoscopic biopsy.

We have excluded all the patients with a pancreatic protocol Computed Tomography suggesting another type of periampullary tumor and secondary invasion of the ampulla of Vater. The patients were considered cancer colon pain of the surgical group if the primary therapeutic approach was a laparotomy, with a palliative biliary, digestive or double by-pass for locally advanced or metastatic disease or radical procedure pancreatoduodenectomy.

Patients were considered part of the endoscopic group if the primary procedure was the insertion of a biliary stent for the biliary decompression. Patients with cholangitis and stent insertion were considered from the surgical group if after stent insertion a laparotomy was performed. Patients without cholangitis with a stent insertion and a secondary laparotomy were considered a failure of the endoscopic treatment.

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Continuous variables are presented as mean ± standard deviation, and the categorical variables as number percentage. The probability p to decline the null hypothesis was set at 0. Results During 5 years we have selected 48 patients cu ampulla of Vater carcinoma,