Distended glands or overreplacement of ampullary mucosa at the papilla of Vater.
OBJECTIVE
The role of the ampullary mucosa, especially its distended glands at the papilla of Vater, has not been fully explored.


METHODS
Twenty-nine pancreatoduodenectomized specimens from pancreatobiliary diseases and 44 autopsied cases, as controls, were studied histopathologically and immunohistochemically.


RESULTS
In 12 out of the 29 pancreatoduodenectomized cases the ampullary mucosa was in contact with the duodenal mucosa just at the outlet of the ampulla. In the remaining 17 cases, the ampullary mucosa overgrew beyond the ostium, replacing a portion of the surrounding duodenal mucosa, termed "distended glands," which measured an average of 1532 microm in length. The muscularis mucosae of the duodenum and the Oddi's sphincter muscle merged in an "end-to-end, sharp-angled" manner at the ostium in the former, whereas this occurred in an "end-to-side, less sharp, rather right-angled" manner in the latter. Immunohistochemically, the distended glands in some cases showed negative/weakly positive staining for anti-carbohydrate antigen (CA) 19-9 and a high proliferation index evaluated using Ki67. In the autopsied materials, distended glands were found in 24 out of the 44 cases.


CONCLUSIONS
Distended glands of the ampullary mucosa were frequently found and only grew on the Oddi's sphincter muscle extension. They may represent not only malignant change but also an adaptive phenomenon for bile and pancreatic juice flow.
Suda
Koichi
K
Department of Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Ootaka
Masahiko
M
Yamasaki
Shigetaka
S
Sonoue
Hiroshi
H
Matsubara
Kenro
K
Takase
Masaru
M
Nobukawa
Bunsei
B
Suzuki
Fujihiko
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D001706:Biopsy; D018395:CA-19-9 Antigen / Q000378:metabolism; D049109:Cell Proliferation; D002908:Chronic Disease; D003138:Common Bile Duct Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010195:Pancreatitis / Q000473:pathology
D018395:CA-19-9 Antigen