Pedunculated Ampullary Adenoma Recurs as Carcinoma After Ampullectomy

Joon Han Jeon, MD, Dae Young Cheung, MD, Kwang Yeol Paik, MD, Seong Jin Lee, MD, Hyun Jin Kim, MD, Hye Kang Kim, MD, Hyung Jun Cho, MD, Wook Kim, MD

Department of Gastroenterology, the Catholic University of Korea, College of Medicine, Seoul, South Korea (Drs. Jeon, Cheung, Lee, H. J. Kim, H. K. Kim, Cho). Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul, South Korea (Drs. Paik, W. Kim).

ABSTRACT

Introduction: Pedunculated ampullary adenoma is a rare periampullary tumor. There is still controversy regarding whether to perform local ampullectomy or radical resection for adenomas with severe dysplasia.

Case Description: A 57-year-old man was diagnosed with a large, long pedunculated ampullary tumor arising from the second portion of the duodenum. Histologic examination of the biopsy specimen showed a tubular adenoma with low-grade dysplasia. Laparoscopic transduodenal ampullectomy was conducted, and the tumor was removed surgically with the grossly sufficient free margin. The final histologic examination of the resected tumor showed high-grade dysplasia. Two months later, the mass was found to have recurred and proved to be well-differentiated adenocarcinoma. Finally, the patient underwent pancreaticoduodenectomy.

Discussion: Local resection may be acceptable for benign ampullary tumors. However, radical resection should be considered for suspected adenocarcinoma. It comprises a large tumor size, the presence of intraductal extension, and findings of preprocedural high-grade dysplasia. The decision to perform local resection for large tumors should be made carefully because most large tumors are proved to be cancer, and local resection plays a limited role in ampullary cancer. Radical resection should be considered for suspected adenocarcinoma, especially in cases of large tumors or in the presence of preprocedural high-grade dysplasia.

Key Words: Ampullary neoplasm, Ampullary adenoma, Ampullary carcinoma, Pedunculated ampullary adenoma, Ampullectomy.

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