Ampullary adenocarcinoma

Case contributed by Dr Michael P Hartung

Presentation

Hyperbilirubinemia. Abdominal pain and diarrhea.

Patient Data

Age: 80
Gender: Male
CT

Presentation

Intrahepatic and common bile duct dilation. Dilated pancreatic duct with moderate atrophy. Round, soft tissue mass at the ampulla, mildly distorting the contour of the second portion of the duodenum. No adenopathy. No vascular involvement of potential tumor.

CT

After ERCP and biopsy

New metallic common bile duct stent with improved biliary ductal dilation. New stranding and fluid attenuation about the medial second portion of the duodenum, resulting in luminal narrowing and likely some degree of gastric outlet obstruction. This could represent a combination of intramural and periduodenal hemorrhage/inflammation related to endoscopic biopsy or pancreatitis.      

Labs: CA19-9 = 673

BIOPSY
SPECIMEN TYPE: FNA-DEEP - THIN PREP
BODY SITE: BILE DUCT
SLIDE(S): 2 CB Slide(s) 1 Thin Prep(s)
GROSS DESCRIPTION: 30 mL, Cloudy, Red. Needlewash Received.
Specimen Designated As Periampullary Mass.
RESULTS: Malignant Cells Present Derived From Adenocarcinoma.

Case Discussion

Great example of just how subtle a periampullary tumor can be. This should be strongly suspected given the presence of a "double duct sign". In this case, a rounded soft tissue mass can actually be appreciated at the ampulla.

Following biopsy and placement of a metallic stent, extraluminal, and intramural fluid/blood products are present, likely related to hemorrhage following the biopsy.

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Case information

rID: 59373
Published: 6th Apr 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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