Intraoperative Evaluation of the Extrahepatic Biliary Tree and Ampulla of Vater
Most carcinomas of the extrahepatic bile ducts and ampulla of Vater are diagnosed prior to surgery, so intraoperative consultations usually concern evaluation of resection margins. However, a primary diagnosis of malignancy may be made at the time of frozen section in rare cases, particularly when preoperative biopsy specimens from biliary strictures are nondiagnostic. Inflammatory diseases that affect extrahepatic bile ducts can cause strictures that simulate carcinoma in pancreatobiliary resection specimens. The purpose of this chapter is to (1) discuss the gross and histologic features of benign and malignant extrahepatic bile duct lesions that are encountered during frozen section consultations, (2) address issues related to evaluation of resection margins from bile duct specimens, and (3) review the features of ampullary neoplasms and their mimics.
KeywordsAdenocarcinoma Corticosteroid Adenoma Pancreatitis Luminal
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