Fig. 1Representative endoscopic imaging of ampullary tumors. (A) Papillitis, bulging, and edematous papilla with petechia. (B) Adenoma, discolored lobular/pine cone like tumor. (C) Adenocarcinoma, a reddish coarse nodular tumor associated with erosion and ready bleeding. (D) Adenomyoma, an enlarged major papilla and villous granularities around the papillary orifice. (E) Paraganglioma, even and firm nodular mass with a granular and villous mucosa. (F) Neuroendocrine tumor, bulging of the papilla, which has a smooth surface.
Fig. 2Representative pathologic findings of ampullary lesions. (A) Papillitis (H&E stain, ×200). (B) Tubular adenoma (H&E stain, ×50). (C) Villous adenoma (H&E stain, ×100). (D) Adenocarcinoma-intestinal type (H&E stain, ×100). (E) Adenocarcinoma-pancreaticobiliary type (H&E stain, ×100). (F) Adenomyoma (H&E stain, ×100). (G) Neuroendocrine tumor (H&E stain, ×100).
Fig. 3Endoscopic images of misdiagnosed cases by gross appearance. (A, B) Papillitis misdiagnosed as adenoma. (C) Adenoma misdiagnosed as carcinoma. (D) Carcinoma misdiagnosed as adenoma.
Fig. 4The diagnostic accuracy of biopsy was influenced by the type of endoscope used. (A) Side-viewing versus forward-viewing endoscope (85.7% vs. 45.0%, p=0.004). (B) Final diagnosis, normal or papillitis versus adenoma versus adenocarcinoma (88.9% vs. 72.7% vs. 47.4%, p=0.007). (C) Number of biopsy specimens (2 vs. ≥3, 56.3% vs. 75.0%; p>0.05).
Table 1Treatment Methods according to Final Diagnosis of Ampullary Tumors
Table 2Diagnostic Accuracy of Endoscopic Imaging in 52 Patients with Ampullary Tumors
Table 3Diagnostic Accuracy of First Endoscopic Biopsy in 52 Patients with Ampullary Tumors
Table 4Comparison of Diagnosis by Endoscopic Imaging and First Biopsy in 52 Patients with Ampullary Tumors
Table 5Comparison of Final Diagnosis and Endoscopic Imaging or First Biopsy in Patients with Normal or Papillitis, Adenoma, and Carcinoma