Korean J Hepatobiliary Pancreat Surg.  2013 Nov;17(4):186-190. 10.14701/kjhbps.2013.17.4.186.

Collision tumor of the ampulla of Vater - Coexistence of neuroendocrine carcinoma and adenocarcinoma: report of a case

  • 1Department of Surgery, Chonnam National University College of Medicine, Gwangju, Korea. surgihur@naver.com
  • 2Department of Radiology, Chonnam National University College of Medicine, Gwangju, Korea.
  • 3Department of Pathology, Chonnam National University College of Medicine, Gwangju, Korea.


Herein, we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma (collision tumor) in the ampulla of Vater, which has seldom been reported in the literature. A 51-year-old man presented with a month history of jaundice. MRCP disclosed about 1.9x1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, causing obstructions of distal common bile duct. He underwent pylorus-preserving pancreaticoduodenectomy under the diagnosis on ampulla of Vater cancer. Pathologically, sections on the ampulla of Vater showed conventional ductal adenocarcinoma extended and collided with poorly differentiated neuroendocrine carcinoma. In conclusion, we hereby presented a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma in the ampulla of Vater.


Collision tumor; Ampulla of Vater; Neuroendocrine carcinoma; Adenocarcinoma

MeSH Terms

Ampulla of Vater*
Carcinoma, Neuroendocrine*
Common Bile Duct
Middle Aged


  • Fig. 1 Radiologic findings. (A) Magnetic resonance cholangiogram indicated about 1.9×1.8 cm sized heterogeneously enhancing mass in ampulla of Vater, that led to obstructions of distal common bile duct, and dilatation of biliary tree and Wirsung duct. (B) There were no remarkable enlarged lymph nodes on scanned abdomen.

  • Fig. 2 ERCP findings. (A) Huge and prominent papilla was noted on ERCP. (B) ERCP cholangiogram also revealed dilated common bile ducts with asymmetrical irregular strictures.

  • Fig. 3 Microscopic findings. (A) Collision site shows abrupt morphologic alterations between usual adenocarcinoma and poorly differentiated endocrine carcinoma (hematoxylin & eosin, ×100). (B, C and D) In immunohistochemical staining, tumor cells of the poorly differentiated neuroendocrine carcinoma are immunoreactive for CD56, neuron specific enolase (NSE), and synaptophysin, respectively.


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