Treatment of @entity5493 that may harbor XXXX .

@entity1 @entity5493 @entity652 @entity4318 @entity5 @entity75 @entity189 @entity876 @entity982 @entity2513 @entity204 @entity420
@entity5493 of the ampulla of Vater is a rare @entity5 . It is a @entity5 because it is a @entity75 and biopsies of the lesion are false negative in 25% to 56% of @entity1 . The primary focus of this report @entity4318 of 30 @entity1 with @entity5493 of the ampulla of Vater who underwent Whipple operations. @entity982 blocks from 22 @entity1 were available. In eight @entity1 , blocks of the biopsies and the corresponding resected specimens were available. Immunohistochemical studies using antibodies to @entity876 and Ki-67 were performed to determine whether accumulation of these antibodies in the biopsy specimens would identify false negative biopsies. There was one @entity204 . The 2-, 5-, and 10-year survival rates for the 22 @entity1 surviving a Whipple operation were 74%, 57%, and 35%, respectively. Three @entity1 died of @entity5 . The mean @entity876 expression index was increased in @entity2513 to 114 (P = 0.01), compared with 12.6 for normal ampullary epithelium adjacent to @entity5 . Significant differences in the Ki-67 proliferation index were noted between normal adjacent epithelium (13%), @entity652 (34%, P = 0.0002), and @entity189 (53%, P = 0.034), as well as between adenomatous epithelium and @entity189 (34% vs. 53%, P = .012). @entity420 was present in 65% of @entity1 with @entity5493 (87% if @entity1 with @entity189 in situ in resected specimens are included). Because of the high false negative rate of ampullary biopsies, and the inability to accurately stage these lesions, we recommend pancreaticoduodenectomy in most @entity1 . Studies with @entity876 and Ki-67 markers suggest that they may be helpful in the recognition of ampullary villous @entity5 not identified on routine biopsies.
