2023 Volume 37 Issue 5 Pages 904-911
A 70-year-old man presented with bile duct dilatation on serial follow-up plain CT scans four years after a distal gastrectomy for gastric cancer. Contrast-enhanced CT showed swelling of the ampulla of Vater (AV) and dilatation of the common bile duct with enhancement of the thickened wall. Intraductal ultrasound showed circumferential wall thickening in continuity from the intrapapillary bile duct (Ab) to the distal bile duct (Bd). The brushing cytology obtained from the Ab and terminal Bd revealed class V, suggesting adenocarcinoma. The patient underwent pancreatoduodenectomy because of suspected carcinoma of the AV extending to Bd. A pathological examination showed flat intraepithelial carcinoma (FIC) of the AV superficially extending to both the Bd and origin part of the main pancreatic duct. The lamina propria of the Ab and intrapapillary pancreatic duct was thick with chronic duodenal papillitis.
The detection of FIC without invasive carcinoma on imaging is challenging. This is a clinically significant case where biliary-imaging changes reflecting the associated chronic duodenal papillitis provided the opportunity to diagnose ampullary FIC.
