title: Clinicopathologic features of ampullary carcinoma without jaundice.
abstract: OBJECTIVE
  To evaluate clinicopathological features of ampullary carcinoma without jaundice.
  
  
  BACKGROUND
  : Obstructive jaundice is the most common symptom of patients with ampullary carcinoma. However, some patients with ampullary carcinoma do not have jaundice at the time of diagnosis.
  
  
  METHODS
  Clinicopathologic findings of 23 patients with ampullary carcinoma showing no visible jaundice (serum total bilirubin <3.0 mg/dL) and 38 patients with ampullary carcinoma showing jaundice at the time of diagnosis were retrospectively compared.
  
  
  RESULTS
  Fifteen of 23 patients with nonjaundiced ampullary carcinoma complained of fever and/or abdominal pain. Five asymptomatic patients were found to have a dilated bile duct on screening ultrasound or to have a tumor-like swelling of the papilla of Vater during routine upper gastrointestinal endoscopy. There was no significant difference in age, sex, size, macroscopic type, histologic type, rates of duodenal invasion, pancreatic invasion, and lymph node metastasis, and prognosis between the two groups. The cumulative 5-year and 10-year survival rates of nonjaundiced patients were 70.2% and 49.0%, compared with 33.6% and 29.4% of jaundiced patients. Ten of the 23 nonjaundiced ampullary carcinomas (43%) were in Stage I, whereas 4 of the 38 jaundiced ampullary carcinomas (11%) were in Stage I (P < 0.01). Mechanisms of nonjaundice in ampullary carcinoma were suspected to be determinant by the infiltrating pattern of the carcinoma to the lower portion of the bile duct.
  
  
  CONCLUSIONS
  Mechanisms of nonjaundice in ampullary carcinoma might be determined by the infiltrating pattern of the carcinoma to the lower portion of the bile. As a greater number of nonjaundiced ampullary carcinomas were in an early stage, detection of them may provide an improved clinical outcome.
authors.affiliation: Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Honkomagome, Tokyo, Japan. kamisawa@cick.jp
authors.forename: Terumi
authors.initials: T
authors.lastname: Kamisawa
authors.forename: Yuyang
authors.initials: Y
authors.lastname: Tu
authors.forename: Naoto
authors.initials: N
authors.lastname: Egawa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Shin-Ichirou
authors.initials: S
authors.lastname: Horiguchi
authors.forename: Kouji
authors.initials: K
authors.lastname: Tsuruta
authors.forename: Atsutake
authors.initials: A
authors.lastname: Okamoto
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D007565:Jaundice / Q000473:pathology; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models