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The ampulla is not covered by the pancreas at the pancreaticoduodenal junction (groove), where ampullary tumors often invade into the periduodenal soft tissues and duodenal serosa without having to go through the pancreas. Therefore, for proper staging of ampullary tumors in this plane, it is important to ink the serosa at the groove area and take perpendicular sections (from tumor to the serosa) to document the tumor spread to this region, which is common in our experience.
