A rare case of periampullary carcinoma with ectopic ending of Vater's ampulla.
A 71-year-old woman was referred to our department complaining of painless progressive jaundice for the last 3 mo. Magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRCP) showed the ectopic hepatopancreatic ampulla draining into the fourth part of the duodenum adjacent to the duodenojejunal flexure; the irregular morphology of the duodenojejunal flexure likely due to a soft tissue mass. Laparotomy confirmed the presence of the abnormal ampulla of Vater located at the fourth part of the duodenum and a soft tissue tumor about 6 cm x 5 cm x 5 cm with a peduncle adjoining the ampulla. Resection of the tumor, including some peripheral tissue, and a Roux-Y loop anastomosis choledochojejunostomy were performed. Pathological examination indicated an intestinal villous adenoma accompanied by severe dysplasia and focal canceration. Periampullary carcinoma with ectopic ending of the Vater's ampulla into the fourth part of the duodenum is rather rare. The embryonic genetic background of this anomaly has not yet been fully explained. It is worth mentioning that MRCP is useful for demonstrating anomalies and anatomic variants of the biliary tract system and pancreatic duct.
Jin
Shu-Guang
SG
Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
Chen
Zhe-Yu
ZY
Yan
Lu-Nan
LN
Zeng
Yong
Y
Huang
Wei
W
Xu
Nan
N
D018253:Adenoma, Villous / Q000175:diagnosis* / Q000473:pathology; D000368:Aged; D014670:Ampulla of Vater / Q000002:abnormalities* / Q000473:pathology; D014408:Biomarkers, Tumor / Q000378:metabolism; D049448:Cholangiopancreatography, Magnetic Resonance; D004379:Duodenal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007565:Jaundice / Q000150:complications; D007813:Laparotomy
D014408:Biomarkers, Tumor