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Invaginated ampulla of Vater in synchronous malignant intraductal papillary mucinous neoplasm of the pancreas and common bile duct cancer

Authors
 J. W. Han  ;  S. I. Jang  ;  D. W. Ma  ;  S. O. Yoon  ;  D. K. Lee 
Citation
 ENDOSCOPY, Vol.45(s02) : 25-26, 2013 
Journal Title
 ENDOSCOPY 
ISSN
 0013-726X 
Issue Date
2013
MeSH
Adenocarcinoma/pathology* ; Adenocarcinoma, Mucinous/pathology ; Ampulla of Vater/pathology* ; Carcinoma, Pancreatic Ductal/pathology* ; Carcinoma, Papillary/pathology* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/pathology* ; Female ; Humans ; Middle Aged ; Neoplasms, Multiple Primary/pathology* ; Pancreatic Neoplasms/pathology*
Keywords
Adenocarcinoma/pathology* ; Adenocarcinoma, Mucinous/pathology ; Ampulla of Vater/pathology* ; Carcinoma, Pancreatic Ductal/pathology* ; Carcinoma, Papillary/pathology* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/pathology* ; Female ; Humans ; Middle Aged ; Neoplasms, Multiple Primary/pathology* ; Pancreatic Neoplasms/pathology*
Abstract
A 61-year-old woman was admitted for upper abdominal pain and fever. Laboratory findings showed raised neutrophil ratio and amylase and lipase levels. Abdominal computed tomography (CT) scan revealed diffuse swelling of the pancreas with peripancreatic fluid, and mild dilatation of the mid-pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed dimpling of the ampullary orifice ([Fig. 1]). We inserted an endoscopic retrograde pancreatic drain (ERPD) via a guide wire. A pancreatogram showed pancreatic duct dilatation and deformity ([Fig. 2]) and due to stricture of the pancreatic duct orifice, the ERPD required repositioning. During removal of the ERPD for repositioning, the ampullary orifice, which was invaginated, protruded into the duodenal lumen ([Fig. 3]). A biopsy specimen was taken from the invaginated ampullary orifice, and confirmed to be adenocarcinoma. The patient underwent pylorus-preserving pancreaticoduodenectomy. The postoperative pathology report confirmed the diagnosis of a double primary tumor: the first tumor being a malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas and the other an adenocarcinoma of the common bile duct (CBD). Histologic exam documented anomalous union of pancreaticobiliary duct with short segment common channel and separated incidental IPMN of main duct in pancreas head. Protruded mass of ampulla of Vater was confirmed as CBD originated.
Full Text
https://www.thieme-connect.com/DOI/DOI?10.1055/s-0032-1326106
DOI
10.1055/s-0032-1326106
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Dong Ki(이동기) ORCID logo https://orcid.org/0000-0002-0048-9112
Jang, Sung Ill(장성일) ORCID logo https://orcid.org/0000-0003-4937-6167
Han, Jung Woo(한정우)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/87953
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