Carcinoma of the papilla of Vater accompanied by non-invasive adenomatous component (NAC).

Surgical specimens from 40 patients with carcinoma of the papilla of Vater were submitted to histopathological analysis of tumor. The lesions were divided into two groups: non-invasive adenomatous component (NAC)-positive carcinoma and NAC-negative carcinoma. NAC was observed in 44% of our series. The incidence of the NAC-positive carcinoma declined with advancing cancer stage, but there was no significant relationship between the tumor size and the presence of NAC. NAC was shown to co-exist in 65% of tumor-forming type carcinomas, 0% of ulcerating type and 38% of the mixed type. The NAC-negative carcinoma invaded or metastasized to the pancreas, duodenum, lymph nodes or veins more frequently than NAC-positive carcinoma. Five year survival rates of patients with NAC-positive and NAC-negative carcinomas were 78% and 21%, respectively (p < 0.01). Patients with NAC-positive carcinoma, most of which were detected preoperatively by endoscopic biopsy, underwent a standard pancreatoduodenectomy with Level 1 lymph node (peripancreatic) dissection. It is considered that pylorus and duodenal bulb-preserving pancreatoduodenectomy is an alternative for patients with localized lesion, while patients with NAC-negative carcinoma should be treated by performing pancreatoduodenectomy together with extended lymph node dissection.