A CARCINOMA IN ADENOMA ARISING FROM THE AMPULLA OF VATER ASSOCIATED WITH EARLY GASTRIC CARCINOMA -A CASE REPORT AND REVIEW OF THE LITERATURE-

Abstract

A 59-year-old man was admitted to Gunma University Hospital in March 1986, because of a gastric cancer detected on gastrofiberscopy. Preoperative fiberoptic study of the duodenum revealed a tumor of the ampulla of Vater which was 2cm in size, papillo-villous on the surface, and elevated from a wide base. The biopsy indicated group III adenoma. Operation was carried out under the final diagnosis of early gastric cnacer and adenoma of the ampulla of Vater. At surgery, gastric cancer was revealed to be early stage and a tumor of the ampulla was found by duodenotomy. Distal gastrectomy with lymphadenectomy and B-I reconstruction was carried out. Pancreatic and biliary outflow were reconstructed using a double sphincteroplasty technique after wide submucosal resection of the tumor. Microscopically, the gastric cancer was a moderately differentiated adenocarcinoma with submucosal invasion. The tumor of the ampulla of Vater was a carcinoma in adenoma of Ampulla doudeni.