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Ampullary adenocarcinoma

Case contributed by Dr Amr Farouk

Presentation

Recent onset of jaundice 3 weeks ago.

Patient Data

Age: 50 years
Gender: Female
MRI

Marked dilatation of the intrahepatic biliary radicles and common bile duct down to its distal portion where it shows smooth tapered end with no MR evidence of intra-luminal filling defects or obstructing calculi. Thickening of the second part of the duodenum with thickened bulging ampulla is noted. No gallbladder calculi could be seen.

CT

Dilatation of the intrahepatic biliary radicles and common bile duct down to its distal portion with thickening of the second part of the duodenum and thickened bulging ampulla.

Case Discussion

Distal biliary obstruction with ampullary thickening and no obstructing calculi making the possibility of a neoplastic process most likely.

ERCP and biopsy were done from an obstructing ampullary mass. Examined sections revealed a portion of the duodenal mucosa showing infiltrating tumor tissue formed of solid sheets and cribriform structure lined by moderate to markedly pleomorphic malignant epithelial cells with high nucleo/cytoplasmic ratio and surrounding moderate desmoplasia. Final pathology diagnosis was ampullary mass showing infiltrating poorly differentiated adenocarcinoma (grade II-III).

 

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