title: A case of gastrointestinal stromal tumour of the ampulla of Vater.
abstract: Gastrointestinal stromal tumour rarely develops in the duodenal ampulla region. We report here a case of gastrointestinal stromal tumour of the ampulla of Vater found in a 44-year-old Japanese man presenting with biliary obstruction. He died of hepatic failure with diffuse liver metastasis. The postmortem examination showed a large Borrman type III-like tumour in the duodenal ampullary region with direct invasion of the pancreas and extrahepatic bile duct as well as metastases to the liver and regional lymph nodes. The duct orifice was located at the centre of the tumour. Microscopically, the tumour consisted of anaplastic spindle cells with high mitotic activity (90 mitoses per 50 high-power fields). Immunohistochemically, the spindle cells were positive for KIT and CD34. The final diagnosis was high-grade malignant gastrointestinal stromal tumour of the ampulla of Vater. Considering the recent advances in the diagnosis and treatment of gastrointestinal stromal tumour, this neoplasm should be included in the differential diagnosis of the tumours appearing in the duodenal ampulla region.
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Matsushita
authors.forename: Y
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: H
authors.initials: H
authors.lastname: Kobayashi
authors.forename: M
authors.initials: M
authors.lastname: Nagasawa
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D014670:Ampulla of Vater / Q000000981:diagnostic imaging / Q000473:pathology*; D018952:Antigens, CD34 / Q000032:analysis; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D017809:Fatal Outcome; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D007564:Japan; D007565:Jaundice / Q000209:etiology; D008297:Male; D019009:Proto-Oncogene Proteins c-kit / Q000032:analysis; D011859:Radiography; D014463:Ultrasonography
chemical_list: D018952:Antigens, CD34; D019009:Proto-Oncogene Proteins c-kit