Correlation between Immunohistochemical and Histomorphological Features of Ampullary Carcinomas: A Study on 72 Cases from a Tertiary Health Care Center
Table 2
Gross findings
Extent of spread
Microscopic findings
Immunohistochemistry
Serial no.
Biopsy number
Age/sex
Clinical details
Radiological findings
Type of specimen
Pattern of growth
Size
Morphology
Local extent of spread
Lymph node involvement
Architecture
Cell height
Nuclear atypia
Stromal desmoplasia
Impression
Extent
Intensity
Extent
Intensity
Inference in IHC
Correlation
1
2414/10
48/F
Obstructive jaundice for 6 months
CT shows a small enhancing lesion in D2. Endoscopy shows bulky ampulla with small ulcer
Whipple’s specimen
Intra-ampullary
Nodular mass
Infiltration into pancreas seen
1/6
Tubule, trabeculae
Low columnar
--
--
Pancreatobiliary
3
++
--
--
Pancreatobiliary
Present
2
2041/10
58/F
Obstructive jaundice for 3 months
Endoscopy shows fleshy ampulla
Whipple’s specimen
Intra-ampullary
Nodular mass
Infiltration into wall of duodenum and bile duct
-
Tubule, papillae, solid pattern
Tall columnar
+
--
Pancreatobiliary
3
++
--
--
Pancreatobiliary
Present
3
2208/09
44/M
Jaundice-3 weeks
Endoscopy shows nodular mass
Whipple’s specimen
Periampullary
Nodular mass
Infiltration into wall of duodenum and bile duct
—
Tubules, papillae
Tall columnar
+ to +++
-
Intestinal
3
+++
--
--
Pancreatobiliary
x
4
1134/10
55/F
Obstructive jaundice
Endoscopy shows prominent ampulla
Endoscopic biopsy
Intra-ampullary
-
-
-
Tubules
Cuboidal
--
+
Pancreatobiliary
3
+++
-
--
Pancreatobiliary
Present
5
1937/10
59/F
Jaundice for 3 weeks
CT shows periampullary mass with dilated CBD
Whipple’s specimen
Periampullary
Ulceroproliferative growth
Infiltration into duodenal wall and focally in to pancreas
-
Tubules, papillae
Tall columnar
+
+
Intestinal
--
--
3
--
Intestinal
Present
6
1883/07
40/M
Jaundice 1 month
Endoscopy showed a friable prominent ampulla
Whipple’s specimen
Intra-ampullary
Friable nodular mass
Infiltration into pancreas and duodenal wall
1/4
Tubules, cords, and groups
Low columnar
++
+++
Pancreatobiliary
3
+++
--
--
Pancreatobiliary
Present
7
8707/10
72/male
Jaundice 2 weeks. Known case of tuberculosis
Endoscopy showed a periampullary growth
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules, papillae, focal cribriform
Low columnar to tall columnar
+ to++
+
Pancreatobiliary
3
+++
--
--
Pancreatobiliary
Present
8
8764/10
57/male
Recurrent pancreatitis, abdominal pain 6 months
Endoscopy large ampullary growth
Endoscopic biopsy
Ampullary
1 cm
Nodular mass
—-
—-
Tubules, papillae
Tall columnar
++
-
Intestinal
--
--
2
+++
Intestinal
Present
9
S810/10
38/male
Jaundice 2 weeks
Endoscopy polypoid pedunculated mass
Whipple’s specimen
Periampullary
Polypoid pedunculated mass
—
2/8
Tubules, papillae
Low columnar to tall columnar
++
++
Intestinal/pancreatobiliary
3
+++
2
++
Intestinal/pancreatobiliary
Present
10
S1184/10
78/male
Obstructive jaundice, abdominal pain 1 month
USG-mass in the head of the pancreas, endoscopy-prominent ampulla
Whipple’s specimen
Ampullary
Ill circumscribed firm bulky mass
Infiltration in to duodenal wall
-
Tubules, cribriform and solid pattern
Cuboidal to tall columnar
+ to ++
++
Intestinal/pancreatobiliary
3
+++
3
++
Intestinal/pancreatobiliary
Present
11
S1444/10
68/male
Loss of weight, jaundice 1 month
Endoscopy-friable ulcerated ampulla
Endoscopic biopsy
-
-
-
-
-
Tubules
Low columnar
+++
+
Pancreatobiliary
3
+++
--
--
Pancreatobiliary
Present
12
S188/09
57/male
Jaundice, abdominal pain 1 month
Endoscopy-duodenal ulcer with a mass in the ampullary region
Whipple’s specimen
Periampullary
Ulcer with raised margins
Infiltration in to duodenal wall and pancreatic parenchyma
3/6
Tubules, papillae
Tall columnar
++
+
Pancreatobiliary/intestinal
2
++
1
+
Pancreatobiliary/intestinal
Present
13
S1264/07
52/male
Jaundice, loss of weight 1 month
Endoscopy-ulcer in ampullary region
Whipple’s specimen
Periampullary
Ulcer in duodenal lumen
Infiltration in to duodenal wall
3/5
Tubules, sheets, and cords
Low columnar to tall columnar
++
++
Pancreatobiliary/intestinal
3
++
1
+
Pancreatobiliary/intestinal
Present
14
S2691/08
55/male
Abdominal pain and jaundice for 2 weeks
CBD showed an area of hard stricture with occlusion of lumen
Whipple’s specimen
Ampullary
1.5 cm
Edema of ampullary mucosa, stricture with occlusion of CBD lumen
Infiltration in to wall of duodenum, CBD, pancreas
1/5
Tubules
Cuboidal to low columnar
+++
++
Pancreatobiliary
1
+
--
--
Pancreatobiliary
Present
15
S3074/09
50/male
Jaundice, fever, vomiting for 3 months
Endoscopy-ampullary prominence
Whipple’s specimen
Ampullary
1.5 cm
Nodular projection at ampulla
—
1/1
Tubules, papillae
Tall columnar
+
++
Intestinal
3
+++
--
--
Intestinal
x
16
S4966/09
65/male
Obstructive jaundice 4 months
CT-dilated CBD and pancreatic duct
Endoscopic biopsy
Intra-ampullary
—
Ampullary prominence
—
—
Tubules, cribriform
Low columnar
+++
++
Pancreatobiliary
1
--
--
--
Pancreatobiliary
Present
17
S2724/09
53/male
Jaundice, vomiting 15 days
CT-IHBR dilatation, mass lesion in periampullary region of CBD
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules, cribriform
Tall columnar
++
--
Intestinal
1
--
1
+
Pancreatobiliary/intestinal
Present
18
S853/09
47/male
Abdominal pain, loss of weight, jaundice 2 months
USG-dilated CHD, CBD up to terminal end
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules
Low columnar
+
+
Pancreatobiliary
2
--
--
--
Pancreatobiliary
Present
19
S1281/08
57/male
Obstructive jaundice 2 months
ERCP-periampullary growth
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules, cribriform
Low columnar
+++
+
Pancreatobiliary
3
--
--
--
Pancreatobiliary
Present
20
S4369
66/male
Itching, loss of appetite 2 months
Endoscopy-growth in D2, dilated CBD
Whipple’s specimen
Periampullary and ampullary
—
Ulceroproliferative growth
Involve adjacent duodenum pancreatic parenchyma and CBD
5/10
Papillary, cribriform
Tall columnar
+++
+
Pancreatobiliary
3
--
1
+
Pancreatobiliary/intestinal
x
21
S2193/16
60/male
Obstructive jaundice 4 months
Endoscopy ampullary growth
Endoscopic biopsy
Intra-ampullary
-
Ampullary prominence
-
-
Tubules, papillae
Low columnar
++
+
Pancreatobiliary
2
--
--
--
Pancreatobiliary
Present
22
1640/09
60/male
Itching, abdominal pain, and jaundice for 1 month
USG-mass in pancreas. Endoscopy ampullary prominence
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules
Cuboidal to low columnar
++
+
Pancreatobiliary
--
-
--
--
Intestinal
x
23
558/07
52/male
Obstructive jaundice
CT-dilated main pancreatic duct and CBD up to ampulla. No mass lesion
Endoscopic biopsy
Periampullary
-
-
-
-
Tubules, papillae
Tall columnar
+
--
Intestinal
1
+
--
--
Pancreatobiliary
x
24
4267/09
70/male
Obstructive jaundice
Endoscopy-friable growth ampullary region
Endoscopic biopsy
Ampullary
-
-
-
-
Tubules, papillae
Low columnar to tall columnar
++
++
Pancreatobiliary
3
+++
--
--
Pancreatobiliary
Present
25
4084
51/male
Recurrent pancreatitis 6 months
Endoscopy ulceration in the periampullary region
Whipple’s specimen
Periampullary
Ulcerated lesion with raised borders
-
-
Tubules, cribriform, papillae
Tall columnar to cuboidal
+
+
Intestinal
1
+
2
++
Pancreatobiliary/intestinal
Present
26
4675/10
56/male
Pancreatitis, cholecystitis 1 month
Dilated IHBR
Whipple’s specimen
Ampullary
Ampullary prominence
-
2/8
Tubules
Cuboidal to low columnar
+++
++
Pancreatobiliary
3
+++
--
--
Pancreatobiliary
Present
27
3826/10
65/male
Obstructive jaundice 1 month
Moderately dilated intra- and extrahepatic biliary channels and pancreatic duct