Ampullary carcinoma

Case contributed by Safwat Mohammad Almoghazy
Diagnosis almost certain


Jaundice, pruritus, abdominal pain and deranged LFTs.

Patient Data

Age: 50 years.
Gender: Male

A tiny nodule was seen in the right middle lobe. 

A hypovascular mass of ampulla and associated marked dilatation of common bile duct and intrahepatic bile ducts. The pancreatic duct is prominent and not dilated.

Normal fat planes preserved around major abdominal aortic branches. 

No sizable lymphadenopathy. 

The liver is average size and density with no definite suspicious focal lesions.

The pancreatic head, neck, body and tail showing normal enhancement with no definite suspicious lesions seen

 Unremarkable CT features of the portal vein, spleen, adrenals, kidneys, urinary bladder, and visualized bowel loops.

No ascites were seen.

The visualized osseous structures showing small bony defect seen in the right iliac bone with an adjacent small bony projection which appearing of benign nature could be due to the previous operation for clinical history correlation with no definite suspicious bony lesions. 

Case Discussion

  • the patients typically present with symptoms related to biliary obstruction of, Painless jaundice, pruritus, abdominal pain and an increased liver enzyme
  • patient subjected to US abdomen and revealed dilated CBD and intrahepatic biliary radicles
  • then requested for CT abdomen and pelvis shows; the above-mentioned findings of an ampullary lesion and double duct sign in not displayed here,  A normal-sized pancreatic duct does not exclude the diagnosis of ampullary neoplasm because the ductal caliber will be normal in up to 50% in patients with bile duct obstruction caused by an ampullary tumor
  • then endoscopic biopsy of this lesion showed adenocarcinoma of the ampulla of Vater
  • then lastly subjected to Whipple's operation and the patient is good and underwent follow up

Ampullary carcinoma is a rare malignant tumor originating at the ampulla of Vater, in the last centimeter of the common bile duct, where it passes through the wall of the duodenum and ampullary papilla. 

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