A case of Intra-amupullary type ampulla of Vatar adenocarcinoma diagnosed by endoscopic ultrasound-guided fine needle aspiration

Abstract

A 67-year old male who have been detected hepatic enzyme disorder was referred to our center for examination and treatment. Abdominal CT, Duodenoscopy and EUS revealed intra-amupullary type ampulla of Vatar tumor. Brushing cytology and forceps biopsies under ERC from the papilla lesion showed mild atypical epithelium; hence it is difficult to distinguish papillitis as being different from adenocarcinoma. Accordingly we performed EUS-FNA for papilla of Vatar lesion, and could obtain diagnosis of adenocarcinoma. Therefore pancreatoduodenectomy was performed and pathological examination for resected specimen showed well differentiated adenocarcinoma involving the duodenal muscularis but not exposed to duodenal mucosa (JSBS classification; 8×8 mm, panc0, du1, T2N0M0, stage II). EUS-FNA for papilla of Vatar lesion is useful when impossibility of diagnosis by biopsy under ERC.