Ictericia obstructiva por neuroma de amputación de vía biliar: Reporte de caso / Obstructive ictericia by neuroma of amputation of via biliar: Case report

Los neuromas del conducto biliar se desarrollan a partir de las fibras nerviosas simpáticas y parasimpáticas que envuelven la pared de la vía biliar. Mujer de 44 años de edad con antecedente de colecistectomía convencional seis meses previos al ingreso acude a emergencia por ictericia obstructiva de 15 días de evolución. En los estudios de imagen impresiona la presencia de una masa a nivel de las vías biliares considerándose el diagnostico de una neoplasia maligna. Por los antecedentes, ausencia de marcadores tumorales se decide realizar una biopsia percutánea sin resultados concluyente, realizándose posteriormente una intervención quirúrgica con estudio anatomo-patológico compatible con neuroma de amputación de vía biliar. El neuroma de amputación a nivel de la vía biliar es un tumor infrecuente. Puede manifestarse clínicamente como una ictericia obstructiva y suele simular a un tumor maligno de las vías biliares. El manejo quirúrgico es el tratamiento definitivo.

Neuromas of the bile duct develop from the sympathetic and parasympathetic nerve fibers that surround the wall of the bile duct. A 44-year-old woman with a history of conventional cholecystectomy six months prior to hospital admission attended emergency due to obstructive jaundice that lasted 15 days. In the imaging studies, the presence of a mass at the level of the bile ducts is considered, considering the diagnosis of a malignant neoplasm. Due to the antecedents, the absence of tumor markers, it was decided to perform a percutaneous biopsy without conclusive results, performing later a surgical intervention with anatomopathological study compatible with neuroma of biliary tract amputation. The amputation neuroma at the level of the bile duct is an infrequent tumor. It can manifest clinically as obstructive jaundice and usually simulates a malignant tumor of the bile ducts. Surgical management is the definitive treatment.

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

Pancreatoduodenectomía durante el embarazo por adenocarcinoma de ampolla de Vater y posterior resección de recurrencia ganglionar con buen resultado a corto y largo plazo / Pancreatoduodenectomy for ampullary adenocarcinoma and and re-intervention for ganglinonar recurrency

Mujer de 30 años con 13 semanas de su segunda gestación que se presentó con síntomas de anemia severa, hemorragia digestiva alta, dolor epigástrico y baja de peso. Mediante endoscopía alta se diagnosticó un adenocarcinoma bien diferenciado de ampolla de Vater. Se le practicó pancreato-duodenectomía a las 16 semanas de su embarazo sin complicaciones. Durante el seguimiento se identificó recurrencia ganglionar loco-regional 4 meses después por lo que se le realizó parto por cesárea a las 34 semanas con neonato saludable de 2500 gr. Se decidió reintervención para resección de enfermedad ganglionar la cual se realizó con éxito. Lleva 36 meses de seguimiento sin evidencia de recidiva de la enfermedad. Su hija ha tenido un desarrollo normal.

A 30 years old woman in the 13 week of her second pregnancy who had severe anemia, upper gastrointestinal bleeding and weight loss. She was given the endoscopic diagnosis of a well differentiated ampullary adenocarcinoma. She underwent a pancreato duodenectomy during the 16 week of pregnancy without complications. After 4 months of follow up we identified a ganglionar local recurrence so that´s why she underwent a cesarean in the 34 week of pregnancy. The product was a healthy 2500 gr. newborn. We decided a reoperation for the resection of the recurrence and it was carried out successfully. Currently the patient has 36 months of follow up without evidence of recurrence and her baby has a normal grow up.

Current Status of Endoscopic Papillectomy for Ampullary Tumors

Detection of tumors of the ampulla of Vater, including ampullary adenoma, has been improved by routine screening endoscopic procedures and imaging modalities. Endoscopic resection by endoscopic papillectomy is rapidly replacing classic surgical resection and is a less invasive procedure. Endoscopic resection can have a role not only in the final histopathologic diagnosis but also as a definite therapeutic option. However, the indications for endoscopic resection are not fully established, and endoscopic procedures are not standardized. Significant complications, including severe pancreatitis, intractable bleeding and duodenal perforation, are rare but can occur, especially in less experienced hands. Severe pancreatitis is the most feared complication, but it can be prevented by pancreatic duct stent insertion in most cases. However, in some cases, pancreatic stenting can be challenging after resection. Incomplete resections are sometimes performed to avoid complications. Endoscopic surveillance is also important for identifying and managing remnant adenomatous tissue or recurrent lesions. Further technical development is needed to expand the indications for this procedure, minimize complications and ensure a high success rate.

Clinical, Pathological, and Immunohistochemical Features of Adenomyoma in the Ampulla of Vater / 대한소화기학회지

BACKGROUND/AIMS: Ampullary adenomyoma is a benign lesion whose malignant potential has yet to be confirmed. Despite its benign nature, adenomyoma is frequently misdiagnosed as a carcinoma or adenoma and is overtreated by extensive surgery. This study was performed to analyze the clinical, pathological, and immunohistochemical features of adenomyomas in the ampulla of Vater. METHODS: Nine cases of adenomyoma in the ampulla of Vater, diagnosed in Chungbuk National University Hospital between 2008 and 2011, were enrolled in this study. We reviewed the clinical data on the symptoms, laboratory data, and radiologic findings of the abdominal computed tomography and endoscopic retrograde cholangiopancreatography. For pathological analysis, all the slides were reviewed by one pathologist, and immunohistochemical stainings with antibodies against cytokeratin 7 (CK7), cytokeratin 20 (CK20), alpha-smooth muscle actin (alpha-SMA), and Ki-67 antigen were performed. RESULTS: All the cases were CK7 positive and CK20 negative. A strong cytoplasmic expression of alpha-SMA was confirmed in all cases. The Ki-67 index was less than 1% in eight cases and 5% in one case. Four cases underwent endoscopic papillectomy, and one case received surgical ampullectomy during colorectal cancer surgery. Five cases that underwent endoscopic or surgical treatment remained symptom-free for three years. Four cases that were closely observed with repeated endoscopic examinations exhibited no interval changes in the papillary lesions. CONCLUSIONS: Endoscopic biopsy and immunohistochemistry can aid in the diagnosis of ampullary adenomyomas. Endoscopic papillectomy or surgical ampullectomy is adequate for the treatment of symptomatic ampullary adenomyomas.

Necessity of Histologic Confirmation for Adequate Management in Ampullary Tumors / 대한소화기학회지

No abstract available.

Necessity of Histologic Confirmation for Adequate Management in Ampullary Tumors / 대한소화기학회지

No abstract available.

Resultados actuales de la pancreatoduodenectomía para el tratamiento de los tumores periampulares y análisis de factores pronósticos de sobrevida / Results of pancreaticoduodenectomy in the treatment of periampullary tumors

Background: The diagnosis and treatment of periampullary tumors represents a challenge for current medicine. Aim: To review the results of pancreaticoduodenectomy (PDD) in the treatment of periampullary tumors and to identify risk factors that impact the long-term survival. Patients and Methods: We performed a retrospective study of patients who underwent a PDD for periampullary tumors between 1993 and 2009. We reviewed perioperative results and long term survival. We performed a multivariate analysis for long-term survival. Results: A PDD was performed in 181 patients aged 58 ± 12 years (98 females). Piloric preservation was done in 53 percent and a pancreatogastric anastomosis was used in 94 percent of cases. Morbidity was 62 percent and postoperative mortality was 5.5 percent. Pancreatic cancer was the most frequent pathological finding in 41 percent, followed by ampullary cancer in 28 percent and distal bile duct cancer in 16 percent. Median survival was 17 months, with a five years survival of 24 percent. Survival for ampullary tumors was 28 months with a five years survival of 32 percent. The median and five years survival were 14 months and 16 percent for bile duct cancer and 11 months and 14 percent for pancreatic cancer. Multivariate analysis identified tumor type (pancreas /bile duct) and lymph node dissemination as independent predictors of mortality. Conclusions: One quarter of patients experienced long term survival. Mortality predictors were tumor type and lymph node dissemination.

Peri-ampullary collision tumor - high grade neuroendocrine carcinoma and signet ring cell carcinoma: A case report and review of literature.

We report a case of 50-year-old male with obstructive jaundice diagnosed as peri-ampullary collision tumor comprising of large cell neuroendocrine carcinoma and signet ring cell carcinoma. The association of neuroendocrine (usually carcinoids) and adenocarcinoma is extremely uncommon with only few case reports available in the reported literature.

Adenocarcinoma de la ampolla de Vater: a propósito de un caso / Vater's ampulla adenocarcinoma: a propos of a case

El 99 por ciento de los tumores malignos de la ampolla de Vater, son carcinomas. Resultan infrecuentes y de difícil diagnóstico, ya que concurren en el área, las patologías pancreáticas, del tercio distal del conducto biliar común, conducto pancreático y mucosa duodenal adyacente. El término carcinoma ampular no sólo hace referencia a una ubicación topográfica, sino también al origen histológico de los mismos, pues implica que deriva de la mucosa intestinal que tapiza dicha región. Se comunica un caso diagnosticado en el Hospital Militar Docente Dr. Mario Muñoz Monroy, de Matanzas, que acudió con un síndrome ictérico, y luego de realizada la colangiografía retrógrada endoscópica (CPRE) con toma de biopsia, ultrasonido y TAC abdominal, se pudo llegar al diagnóstico de adenocarcinoma mucoproductor de la ampolla de Vater. Fue sometido a cirugía radical con resultado exitoso...

99 per cent of the Vater's ampulla malignant tumours are carcinomas. They are infrequent and of difficult diagnosis, because there is a concurrence in the area of pancreatic diseases, of the distal third of the common bile duct, of the pancreatic duct and the adjacent duodenal mucosa diseases. The term ampullar carcinoma refers not only to a topographic location but also to their histological origin; because it implies that it derives from the intestinal mucosa that coats the region. We deal with a case diagnosed at the Teaching Military Hospital Dr. Mario Muñoz Monroy, of Matanzas, assisting the hospital with an icteric syndrome. After making an endoscopic retrograde cholangiography with biopsy, ultrasound and abdominal tomography, we arrived to the diagnosis of a Vater's ampulla mucoproductor adenocarcinoma. The patient received a radical surgery with successful results...

Hepatectomía derecha tras extirpación de tumor de la ampolla de Vater / Right hepatectomy after excision of a carcinoma of the ampulla of Vater: report of one case

Occasionally hepatectomy for metastases of ampulla of Vater carcinoma can result in a better survival and quality of life of patients. We report a 67 years old male subjected to a duodenopancreatectomy for a carcinoma of the ampulla of Vater that required afterwards a right hepatectomy for metastases. Twenty one months after the second operation and 42 months after the first operation, that patient is asymptomatic and without evidences of relapse.

El tratamiento quirúrgico del carcinoma de ampolla de Vater presenta mejores resultados oncológicos que los del resto de los tumores periampulares. En casos seleccionados, la resección hepática por metástasis de carcinoma de ampolla de Vater extirpado previamente, puede proporcionar supervivencias prolongadas y con buena calidad de vida. Presentamos un paciente de 67 años tratado con duodenopancreatectomía por cáncer de la ampolla de Vater y posteriormente con hepatectomía derecha por metástasis. A los 42 y 21 meses de la primera y segunda intervención respectivamente, permanece asintomático y sin evidencia de enfermedad.

Tumores ampulares: comunicación de un caso y revisión de la literatura / Ampullary tumors: a case report and review of the literature

Los tumores ampulares corresponden a aquellos ubicados en la unión de los segmentos terminales del conducto pancreático y colédoco. Son poco frecuentes, constituyendo entre un 1 a 2 por ciento de los tumores del tracto digestivo. Se caracterizan por su lento crecimiento y por corresponder a los tumores periampulares de mejor pronóstico. Actualmente está en discusión el enfrentamiento terapéutico, en cuanto al tipo de resección para cada tumor y cada paciente. La postura previa ha sido la resección quirúrgica clásica, no obstante está en boga un manejo conservador. Se da a conocer el caso clínico de un hombre de 53 años, que consulta por cuadro de ictericia progresiva, coluria, acolia y dolor abdominal. La ecotomografía y TC de abdomen son sugerentes de neoplasia periampular. La colangiografia endoscópica retrógrada confirmó un tumor ampular de aproximadamente 3 cm. de diámetro. Se realiza papilotomía, instalación de endoprótesis biliar y biopsia de papila. El estudio histopatológico no descarta una neoplasia invasora, por lo que se realiza ampulectomía endoscópica. La biopsia concluye adenoma túbulopapilar.

Carcinoma of periampullary region; histopathological study and correlation with prognosis

Periampullary malignancies are aggressive neoplasms with low survival rates. The factors favoring long-term survival for periampullary neoplasm are related to histopathologic features, site, stage, resection margins and lymph node metastases. To study some clinical and histopathological parameters of cancer head of pancreas and periampullary region. Statistical study of the impact of these parameters on the outcome of malignancy in this region. This study was carried out on 144 cases of penampullary cancers. The clinical data including, pathological data are revised. Special stains and immunohistochemistry are used when necessary. The most common malignant tumor of peniampullary region is carcinoma of ampulla of vater, then cancer head pancreas, then bile duct carcinoma and lastly duodenal carcinoma [43.7%, 40%, 10% and 6.3% respectively]. We found that the median survival of periampullary cancer is 15 months. The prognosis of these malignant tumors is related to site [P=0.0054], size of the tumor [P=0.0005], grade [P=0.0000], lymph node metastasis [P=0.0123] and tumor stage [P=0.0084]. Other parameters including age and sex, local extension and cut margins are statistically of no significant effects on the prognosis. Periampullary carcinomas are aggressive neoplasm with short survival. It seems that our locality shows epidemiologic factors that leads to that the age of patients at time of presentation and prognosis differ from literatures

Carcinoid of ampulla of Vater.

Carcinoid tumors of ampulla are rare clinical entities. They form 0.35% of all the gastrointestinal carcinoids. So far, only 109 cases have been reported in the literature, mostly as individual case reports. Since the metastatic potential and the tumor size have no correlation, unlike in duodenal carcinoids, pancreatoduodenectomy is considered the treatment of choice. Here we present a case of carcinoid of ampulla presenting to our department.

Acral Metastasis in a Patient with Ampullary Carcinoma

Although skin metastasis from a malignant tumor of an internal organ usually occurs at an advanced disease stage, there has been no prior report of a cutaneous acral metastasis from ampullary carcinoma to date. We report a 71-year old male patient with cutaneous metastasis from an ampullary adenocarcinoma. The patient had a history of pylorus preserving pancreaticoduodenectomy for carcinoma of the ampulla of Vater two years prior to presentation. Physical examination revealed ill-defined, painful and hard erythematous nodules at the left thumb and distal phalanx of the right middle finger. The computed tomography scan showed low density masses in the retroperitoneum; the histological examination of a nodule from the right middle finger showed a metastatic adenocarcinoma. This case illustrates that cutaneous metastasis from ampullary carcinoma has a poor prognosis.

Signet ring cell carcinoma of ampulla of Vater in a young adult.

Signet ring cell carcinoma of the ampulla of Vater is extremely rare. The 7 cases reported earlier have been in older patients. We report a 32-year-old lady with this condition, who also had metastases in the bone marrow, vertebrae, lungs and liver.

Adenoma velloso del colédoco con transformación maligna hacia adenocarcinoma bien diferenciado / Coledochal vellous adenoma with malignant transformation

Informar el caso de una paciente de 55 años de edad con diagnóstico de adenoma velloso del colédoco con transformación maligna. Descripción del caso clínico y revisión de la literatura. Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes. Mérida-Venezuela. Se realizó operación de Whipple modificada obteniéndose diagnóstico histológico de adenoma velloso en colédoco con transformación maligna hacia adenocarcinoma bien diferenciado. El adenoma velloso del colédoco es una entidad clínica patológica inusual, y su abordaje puede verse dificultado por ser poco documentado. Obtener un diagnostico definitivo previo es necesario para realizar el procedimiento quirúrgico apropiado.

Disseminated metastasis following periampullary cancer resection masquerading as uveitis.

The Uveitis Masquerade Syndromes (UMS) are a group of ocular diseases that mimic intraocular inflammation, but are in fact neoplastic in nature. We report a patient with disseminated malignancy who presented with uveitis 5 years after an apparently successful resection of periampullary adenocarcinoma. The Masquerade Syndrome was detected by cytological examination of the vitreous.

Expression of Cyclooxygenase-2 and Its Correlation with Clinicopathologic Factors of Ampulla of Vater Cancer

There has been no report for the expression of cyclooxygenase-2 (COX-2) and its clinicopathologic and biologic significance in ampulla of Vater cancer. This study was aimed for the clarification of COX-2 expression and its biologic roles in ampulla of Vater cancer. Fourty-six patients with ampulla of Vater cancer were enrolled and their COX-2 expression and clinicopathologic features were analyzed. The median age of patients was 60 yr and the mean duration of follow-up was 35 months (range: 14-82 months). Immunohistochemical stainings for COX-2, Ki-67, CD34 and TUNEL staining were performed. The immunoreactive COX-2 expression was present in 24 (52.2%) patients of ampulla of Vater cancer and mainly localized in cytosolic and perinuclear region. There was no significant difference in the length of survival between COX-2 postive and negative group (p=0.9420 by Log Rank test). Also, there were no significant differences of proliferation index (p=0.326), apoptotic index (p=0.764) and microvessel density (p=0.135) between COX-2 positive and negative group. Initial pTNM stage (p=0.0028 by Log Rank test) and blood transfusion over 4 pints during operation (p=0.0254 by Log Rank test) were independent prognostic factor in patients with ampulla of Vater cancer. It is suggested that immunoreactivity of COX-2 is not correlated with clinicopathologic and biologic features of ampulla of Vater cancer.