Table 2.
| Gross findings | Extent of spread | Microscopic findings | Immunohistochemistry | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Serial no. | Biopsy number | Age/sex | Clinical details | Radiological findings | Type of specimen | Pattern of growth | Size | Morphology | Local extent of spread | Lymph node involvement | Architecture | Cell height | Nuclear atypia | Stromal desmoplasia | Impression | Extent | Intensity | Extent | Intensity | Inference in IHC | Correlation |
| 1 | 2414/10 | 48/F | Obstructive jaundice for 6 months | CT shows a small enhancing lesion in D2. Endoscopy shows bulky ampulla with small ulcer | Whipple's specimen | Intra-ampullary | 1 × 1 cm | Nodular mass | Infiltration into pancreas seen | 1/6 | Tubule, trabeculae | Low columnar | -- | -- | Pancreatobiliary | 3 | ++ | -- | -- | Pancreatobiliary | Present |
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| 2 | 2041/10 | 58/F | Obstructive jaundice for 3 months | Endoscopy shows fleshy ampulla | Whipple's specimen | Intra-ampullary | 0.8 × 0.5 cm | Nodular mass | Infiltration into wall of duodenum and bile duct | - | Tubule, papillae, solid pattern | Tall columnar | + | -- | Pancreatobiliary | 3 | ++ | -- | -- | Pancreatobiliary | Present |
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| 3 | 2208/09 | 44/M | Jaundice-3 weeks | Endoscopy shows nodular mass | Whipple's specimen | Periampullary | 3 × 1 cm | Nodular mass | Infiltration into wall of duodenum and bile duct | — | Tubules, papillae | Tall columnar | + to +++ | - | Intestinal | 3 | +++ | -- | -- | Pancreatobiliary | x |
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| 4 | 1134/10 | 55/F | Obstructive jaundice | Endoscopy shows prominent ampulla | Endoscopic biopsy | Intra-ampullary | - | - | - | Tubules | Cuboidal | -- | + | Pancreatobiliary | 3 | +++ | - | -- | Pancreatobiliary | Present | |
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| 5 | 1937/10 | 59/F | Jaundice for 3 weeks | CT shows periampullary mass with dilated CBD | Whipple's specimen | Periampullary | 4 × 3 cm | Ulceroproliferative growth | Infiltration into duodenal wall and focally in to pancreas | - | Tubules, papillae | Tall columnar | + | + | Intestinal | -- | -- | 3 | -- | Intestinal | Present |
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| 6 | 1883/07 | 40/M | Jaundice 1 month | Endoscopy showed a friable prominent ampulla | Whipple's specimen | Intra-ampullary | 2 × 3 cm | Friable nodular mass | Infiltration into pancreas and duodenal wall | 1/4 | Tubules, cords, and groups | Low columnar | ++ | +++ | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 7 | 8707/10 | 72/male | Jaundice 2 weeks. Known case of tuberculosis | Endoscopy showed a periampullary growth | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules, papillae, focal cribriform | Low columnar to tall columnar | + to++ | + | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 8 | 8764/10 | 57/male | Recurrent pancreatitis, abdominal pain 6 months | Endoscopy large ampullary growth | Endoscopic biopsy | Ampullary | 1 cm | Nodular mass | —- | —- | Tubules, papillae | Tall columnar | ++ | - | Intestinal | -- | -- | 2 | +++ | Intestinal | Present |
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| 9 | S810/10 | 38/male | Jaundice 2 weeks | Endoscopy polypoid pedunculated mass | Whipple's specimen | Periampullary | 5 × 3 cm | Polypoid pedunculated mass | — | 2/8 | Tubules, papillae | Low columnar to tall columnar | ++ | ++ | Intestinal/pancreatobiliary | 3 | +++ | 2 | ++ | Intestinal/pancreatobiliary | Present |
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| 10 | S1184/10 | 78/male | Obstructive jaundice, abdominal pain 1 month | USG-mass in the head of the pancreas, endoscopy-prominent ampulla | Whipple's specimen | Ampullary | 1.9 × 1.5 cm | Ill circumscribed firm bulky mass | Infiltration in to duodenal wall | - | Tubules, cribriform and solid pattern | Cuboidal to tall columnar | + to ++ | ++ | Intestinal/pancreatobiliary | 3 | +++ | 3 | ++ | Intestinal/pancreatobiliary | Present |
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| 11 | S1444/10 | 68/male | Loss of weight, jaundice 1 month | Endoscopy-friable ulcerated ampulla | Endoscopic biopsy | - | - | - | - | - | Tubules | Low columnar | +++ | + | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 12 | S188/09 | 57/male | Jaundice, abdominal pain 1 month | Endoscopy-duodenal ulcer with a mass in the ampullary region | Whipple's specimen | Periampullary | 1.5 × 1 cm | Ulcer with raised margins | Infiltration in to duodenal wall and pancreatic parenchyma | 3/6 | Tubules, papillae | Tall columnar | ++ | + | Pancreatobiliary/intestinal | 2 | ++ | 1 | + | Pancreatobiliary/intestinal | Present |
| 13 | S1264/07 | 52/male | Jaundice, loss of weight 1 month | Endoscopy-ulcer in ampullary region | Whipple's specimen | Periampullary | 4 × 2 cm | Ulcer in duodenal lumen | Infiltration in to duodenal wall | 3/5 | Tubules, sheets, and cords | Low columnar to tall columnar | ++ | ++ | Pancreatobiliary/intestinal | 3 | ++ | 1 | + | Pancreatobiliary/intestinal | Present |
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| 14 | S2691/08 | 55/male | Abdominal pain and jaundice for 2 weeks | CBD showed an area of hard stricture with occlusion of lumen | Whipple's specimen | Ampullary | 1.5 cm | Edema of ampullary mucosa, stricture with occlusion of CBD lumen | Infiltration in to wall of duodenum, CBD, pancreas | 1/5 | Tubules | Cuboidal to low columnar | +++ | ++ | Pancreatobiliary | 1 | + | -- | -- | Pancreatobiliary | Present |
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| 15 | S3074/09 | 50/male | Jaundice, fever, vomiting for 3 months | Endoscopy-ampullary prominence | Whipple's specimen | Ampullary | 1.5 cm | Nodular projection at ampulla | — | 1/1 | Tubules, papillae | Tall columnar | + | ++ | Intestinal | 3 | +++ | -- | -- | Intestinal | x |
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| 16 | S4966/09 | 65/male | Obstructive jaundice 4 months | CT-dilated CBD and pancreatic duct | Endoscopic biopsy | Intra-ampullary | — | Ampullary prominence | — | — | Tubules, cribriform | Low columnar | +++ | ++ | Pancreatobiliary | 1 | -- | -- | -- | Pancreatobiliary | Present |
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| 17 | S2724/09 | 53/male | Jaundice, vomiting 15 days | CT-IHBR dilatation, mass lesion in periampullary region of CBD | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules, cribriform | Tall columnar | ++ | -- | Intestinal | 1 | -- | 1 | + | Pancreatobiliary/intestinal | Present |
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| 18 | S853/09 | 47/male | Abdominal pain, loss of weight, jaundice 2 months | USG-dilated CHD, CBD up to terminal end | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules | Low columnar | + | + | Pancreatobiliary | 2 | -- | -- | -- | Pancreatobiliary | Present |
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| 19 | S1281/08 | 57/male | Obstructive jaundice 2 months | ERCP-periampullary growth | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules, cribriform | Low columnar | +++ | + | Pancreatobiliary | 3 | -- | -- | -- | Pancreatobiliary | Present |
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| 20 | S4369 | 66/male | Itching, loss of appetite 2 months | Endoscopy-growth in D2, dilated CBD | Whipple's specimen | Periampullary and ampullary | — | Ulceroproliferative growth | Involve adjacent duodenum pancreatic parenchyma and CBD | 5/10 | Papillary, cribriform | Tall columnar | +++ | + | Pancreatobiliary | 3 | -- | 1 | + | Pancreatobiliary/intestinal | x |
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| 21 | S2193/16 | 60/male | Obstructive jaundice 4 months | Endoscopy ampullary growth | Endoscopic biopsy | Intra-ampullary | - | Ampullary prominence | - | - | Tubules, papillae | Low columnar | ++ | + | Pancreatobiliary | 2 | -- | -- | -- | Pancreatobiliary | Present |
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| 22 | 1640/09 | 60/male | Itching, abdominal pain, and jaundice for 1 month | USG-mass in pancreas. Endoscopy ampullary prominence |
Endoscopic biopsy | Periampullary | - | - | - | - | Tubules | Cuboidal to low columnar | ++ | + | Pancreatobiliary | -- | - | -- | -- | Intestinal | x |
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| 23 | 558/07 | 52/male | Obstructive jaundice | CT-dilated main pancreatic duct and CBD up to ampulla. No mass lesion | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules, papillae | Tall columnar | + | -- | Intestinal | 1 | + | -- | -- | Pancreatobiliary | x |
| 24 | 4267/09 | 70/male | Obstructive jaundice | Endoscopy-friable growth ampullary region | Endoscopic biopsy | Ampullary | - | - | - | - | Tubules, papillae | Low columnar to tall columnar | ++ | ++ | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 25 | 4084 | 51/male | Recurrent pancreatitis 6 months | Endoscopy ulceration in the periampullary region | Whipple's specimen | Periampullary | 1 × 2 cm | Ulcerated lesion with raised borders | - | - | Tubules, cribriform, papillae | Tall columnar to cuboidal | + | + | Intestinal | 1 | + | 2 | ++ | Pancreatobiliary/intestinal | Present |
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| 26 | 4675/10 | 56/male | Pancreatitis, cholecystitis 1 month | Dilated IHBR | Whipple's specimen | Ampullary | 1.8 × 0.8 cm | Ampullary prominence | - | 2/8 | Tubules | Cuboidal to low columnar | +++ | ++ | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 27 | 3826/10 | 65/male | Obstructive jaundice 1 month | Moderately dilated intra- and extrahepatic biliary channels and pancreatic duct | Endoscopic biopsy | Periampullary | - | - | - | - | Tubules, cribriform | Low columnar to cuboidal (mucinous) | ++ | +++ | Pancreatobiliary | 3 | +++ | -- | -- | Pancreatobiliary | Present |
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| 28 | 3995/10 | 55/male | Obstructive jaundice | ERCP-periampullary growth | Endoscopic biopsy | Periampullary | - | Periampullary nodular growth | - | - | Tubules, papillae | Cuboidal to tall columnar | + | -- | Pancreatobiliary/intestinal | 3 | +++ | -- | -- | Pancreatobiliary | x |
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| 29 | 680/11 | 55/male | Obstructive jaundice | Endoscopy-periampullary growth | Whipple's specimen | Periampullary | 4 × 2.5 cm | Ulceroproliferative growth | - | - | Tubules, papillae, cribriform | Tall columnar to cuboidal | ++ | +++ | Pancreatobiliary/intestinal | 3 in papillary pattern and negative in tubules | +++ | 2 in papillary to 3 in tubules | ++ to +++ | Pancreatobiliary/intestinal | Present |
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| 30 | 2845/11 | 50/male | Obstructive jaundice | Endoscopy-periampullary ulceroproliferative growth | Endoscopic biopsy | Periampullary | - | Ulceroproliferative growth | - | - | Papillae, tubules | Tall columnar | ++ | ++ | Pancreatobiliary/intestinal | -- | -- | 3 | ++ | Intestinal | x |