Figure 3

Whole-mount section parallel to the ampulla, distal bile duct and pancreatic duct, demonstrating periampullary tumour growth relative to ductal anatomy, for determination of the site of cancer origin. (A) White areas on the macroscopic photograph indicate possible tumour growth. (B) On microscopic examination, this tumour was found to originate from the peri-papillary duodenum (du), although it also involved the entire ampullary region (stapled area), and the distal portions of the distal bile duct (bd) and pancreatic duct (pd). In such cases, and in particular if epithelial dysplasia or in situ neoplasia also affects more than one periampullary sublocation, determination of the cancer origin may be difficult, and virtually impossible without systematic histopathologic examination.