ADENOMA-CARCINOMA SEQUENCE IN THE PAPILLA OF VATER

Background: Our aims were to investigate the question as to whether th e adenoma-carcinoma sequence also applies to the papilla of Vater and to determine the frequency with which a tumour of the papilla of Vater , diagnosed histologically as containing portions of an adenoma, alrea dy contains adenocarcinoma elsewhere. Methods: A retrospective analysi s was carried out of the forceps, snare biopsy, and excised specimens obtained from the papilla of Vater in 559 patients, including 210 pati ents with the primary diagnosis of carcinoma and 110 patients with the diagnosis of 'portions of an adenoma'. Comparisons were made of the a ge distribution of patients with adenoma and those with carcinoma, and the frequency of residual adenoma in a carcinoma as a function of deg ree of malignancy, T stage, and UICC stage. A follow-up examination of the patients with the primary diagnosis 'parts of an adenoma of the p apilla of Vater' was performed. Results: The average age of the patien ts with the final diagnosis adenoma was 65.2 years, and that of the ca rcinoma patients 73.0 years. Residual adenoma was found in 54.9% of th e 51 surgical specimens and in 31.7% of the 159 biopsy specimens obtai ned from carcinomas. The frequency of residual adenoma in carcinomas d ecreased statistically significantly with increasing T stage and degre e of malignancy. The follow-up examination of the 110 patients with th e primary biopsy diagnosis parts of an adenoma of the papilla of Vater showed unequivocal results in 80 cases. Only in 39.7% of these cases was the primary diagnosis adenoma confirmed, whereas in 60.25%, furthe r histologic examination showed a carcinoma. Conclusions: An analysis of our results, together with those reported in the literature, indica tes that the adenoma-carcinoma sequence also applies to the papilla of Vater and that, in a high percentage of patients with the histologic diagnosis 'parts of an adenoma', other regions of the tumour already c ontain a carcinoma.