A Case of Recurrent Ampullar Carcinoma Undergoing Photodynamic Therapy after Surgical Resection

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We report a successful treatment of photodynamic therapy in patients with remnant ampullar carcinoma who underwent local resection of duodenal papilla. A 56-year-old male patient showed ampullar carcinoma without invading pancreas or duodenum. Pancreatic body and tail were obviously atrophic and local resection of duodenal papilla was performed at associated hospital 3 months ago. However, a resected specimen showed the remnant carcinoma at the edge, and the follow-up endoscopy showed a protruding tumor in the resected portion. Similar to the resected specimen, endoscopic biopsy showed a well differentiated adenocarcinoma in this tumor. Since additional resection was difficult because of the pancreatic function, photodynamic therapy with laser beam of 630 nm wavelength by eximer dye laser (4 mJ/pulse, 40 Hz) was applied to the ampullar carcinoma through endoscope for consecutive two days. Follow-up endoscopy performed 4 weeks after photodynamic therapy showed a remarkable reduction of the tumor, and no cancer tissue was observed by a biopsy. Ablation with argon beam laser was additionally applied to the remnant mass region. Tumor recurrence was not observed for 8 months after photodynamic therapy.