1993 Volume 42 Pages 240-243
A 58-year-old female patient was diagnosed as having adenoma of the ampulla of Vater by endoscopic observation and biopsies in 1987. Since then endoscopic examinations with biopsies were performed every six months. Every biopsy specimen showed adenoma with mild dysplasia so far until 1992 when more severe dysplasia than before was found, and malignant transformation was suspected. At duodenotomy a local papillary resection was performed. Histologic examination of the resected specimen showed completely excised papillotubular adenoma with moderately severe dysplasia and without malignancy.
The treatment of adenoma of the ampulla of Vater is controversial, because of the difficulty in discriminating“cancer in adenoma”. Local papillary resection should be regarded as the first choice for adenoma of the ampulla of Vater even if malignant transformation is suspected.
In our case, minimum and complete resection was successfully performed after the rigid follow-up program.
