A case of recurrence of ampullary adenoma in the pancreatic duct that developed into invasive carcinoma after endoscopic and transduodenal resection

Abstract

A 67-year-old man underwent endoscopic papillectomy for ampullary adenoma. The histological findings revealed a tubular adenoma. Endoscopic re-resection and transduodenal resection were performed because the local recurrence of adenoma. Three years later, the patient developed acute pancreatitis, and recurrence in the pancreatic duct was suspected. EUS revealed a low echoic mass in the pancreatic duct, and the pathological findings revealed an adenoma of biopsies from the orifice and pancreatic duct. We diagnosed the recurrence of ampullary adenoma and intraductal extension, and the patient underwent subtotal stomach-preserving pancreaticoduodenectomy. The pathological findings of the resected specimen revealed growth of adenoma in the main pancreatic duct and adenocarcinoma with invasion into the pancreatic parenchyma and duodenal wall. For cases suspected of repeated recurrence after local resection for ampullary adenoma, early pancreaticoduodenectomy should be considered.