Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater

Abstract

By Jorge Albores-Saavedra, Donald Earl Henson, and David S. Klimstra (Atlas of Tumor Pathology, 3rd series, fascicle 27, 365 pp, with illus, Washington, DC, Armed Forces Institute of Pathology, 2000.After 14 years, the long-awaited sequel to the second edition of the fascicle Tumors of the Gallbladder and Extrahepatic Bile Ducts has arrived. At the suggestion of the editor, Dr Juan Rosai, the authors have logically added tumors of the ampulla of Vater in this third series, because tumors of these anatomic sites share similar clinical and pathologic features. In this fascicle, the authors have achieved their goal of updating the information on the clinical and pathologic characteristics as well as the biologic behavior of tumors that arise in this anatomic region. Particular emphasis is given to useful diagnostic light microscopic features and, when appropriate, to results of electron microscopy, immunohistochemistry, and molecular pathology studies. The authors take full advantage of recent technological advances and provide impeccable color images that seamlessly supplement the well-written text. The result is a publication of unparalleled quality on this subject.Following the format of the third series of Armed Forces Institute of Pathology fascicles, this volume begins with a comprehensive review of the anatomy and embryologic development, followed by a detailed discussion of the different tumors of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. Each subject is discussed based on topics that include definition and general features, clinical features, gross findings, pathologic findings, and differential diagnosis. Each chapter ends with a complete list of pertinent references. When necessary, colorful schematic illustrations and radiologic studies, including cholangiography, sonography, and computed tomography, have been added. Histologic classification, TNM tumor staging system, prosection of the pancreatoduodenectomy specimen, and information that must be included in the surgical report are detailed. The role and limitations of cytology and image analysis in the diagnosis of tumor are discussed. The authors have provided different perspectives on the histologic distribution and survival rates for cancers of the gallbladder, extrahepatic bile ducts, and ampulla based on the data from the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute. These are contrasted with the authors' own experiences in various cancer institutes. Comparing the data from the different sources is difficult, a fact that emphasizes the need for uniformity in nomenclature.Particularly impressive are the colorful gross photographs and whole-mount glass slides in the newly added chapter on malignant epithelial tumors of the ampulla. The AJCC/UICC (American Joint Committee on Cancer/Committee of the International Union Against Cancer) staging system for ampullary carcinoma is accompanied by monochromatic illustrations that supplement the text. This chapter also includes comparable survival rates in a tabular format, based on the experiences of different authors.The authors of the 365-page third series of Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater have continued the AFIP's tradition of producing fascicles that have become among the most influential publications on tumor pathology.