Recurrence of early carcinoma in the ampulla of Vater after transduodenal ampullectomy: a case report

Abstract

Dilation of the common bile duct was detected by computed tomography (CT) scan in an 80-year-old woman. Upper gastrointestinal endoscopy revealed a tumor of 3 cm in diameter in the papilla of Vater, and a carcinoma was proven by tumor biopsy. Transduodenal ampullectomy was performed, considering the patient's age and the clinical findings for suspecting early carcinoma. Histopathological examination demonstrated adenocarcinoma (tub1- tub2) in tubulovillous adenoma, with partial invasion into Oddi's muscle. Follow-up CT 3 years after surgery showed recurrence in the lymph nodes at the head of the pancreas, and also the para-aortic and upper mediastinal nodes. The patient died four years after initial surgery. Pancreatoduodenectomy is a standard operation for early stage carcinoma of the ampulla of Vater; however, according to clinical practice guidelines for the management of biliary tract and ampullary tumors, limited resection can be considered for intramucosal carcinoma. However, accurate preoperative diagnosis of intramucosal carcinoma is usually difficult and in our case, the tumor invasion to the Oddi's muscle was detected by postoperative histological examination. Therefore, the indication of limited resection should be strictly judged.