A CASE OF AMPULLARY CARCINOMA WITH A JUMPING METASTASIS TO PARAAORTIC LYMPH NODE

Abstract

A case of ampullary carcinoma with a jumping metastasis to the paraaortic lymph node is presented. A 51-year-old woman was admitted to the hospital because of epigastrial discomfort. Liver dysfunction had been noticed since one year before without a history of jaundice. CA 19-9 level elevated. Intrahepatic bile duct dilatation was detected by ultrasound and computed tomography. Hypotonic duodenography showed a protruded mass, 4cm in size, which was well differentiated adenocarcinoma by endoscopic biopsy. There was no ascites, liver metastasis or peritoneal dissemination on laparotomy. An elastic hard tumor was palpable at the second portion of the duodenum without any invasion to the serosa. A pylorus-preserving pancreatico-duodenectomy was performed with extended lymph node dissection including paraaortic regions, and with intraoperative radiation. The mass was an exposed protruding type, invading the submucosa of the duodenum. The only one paraaortic lymph node was metastasized of all 55 dissected lymph nodes. We conclude that there is a direct stream of lymph from the papilla to paraaorta and that the paraaortic lymph node dissection would be mandatory for surgery of ampullary carcinoma even in an early stage.