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Patient complaining of epigastric pain since 2 months. The endoscopy showed a bulging papilla.
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Small soft tissue mass protruding into the lumen of the 2nd portion of the duodenum associated with dilatation of the CBD (9 mm). The pancreatic duct is within normal limit (3 mm), therefore the "double duct sign" is missing.
There are two tumors that arise from the glandular epithelium of the ampulla of Vater: benign (adenoma) and malignant (adenocarcinoma).
When the tumor is small in size and limited to the ampulla, the endoscopic as well as the radiological appearances may be normal. But if the tumor is larger it can be visible on endoscopy as a prominent papilla or mural mass, and as a soft tissue mass protruding into the 2nd portion of the duodenum with a “double duct sign” on CT or MRI.
The sensitivity and specificity of endoscopic ultrasound in performing preoperative tumor and node staging are superior to those of MRI or CT.
The prognosis is even better for patients with a limited stage of disease.
Additional Contributor: Z.Boudiaf, MD.
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- 2. Keith J Roberts, Neil McCulloch, et al. Endoscopic ultrasound assessment of lesions of the ampulla of Vater is of particular value in low-grade dysplasia. HPB (Oxford) 2013 Jan; 15(1): 18–23.
- 3. Chen CH, Yang CC, Yeh YH, Chou DA, Nien CK. Reappraisal of endosonography of ampullary tumours: correlation with transabdominal sonography, CT, and MRI. J Clin Ultrasound. 2009;37:18–25.