Korean J Pancreas Biliary Tract.  2016 Jul;21(3):163-167. 10.15279/kpba.2016.21.3.163.

Intra-ampullary Adenocarcinoma Presenting as Recurrent Pancreatitis

• Noh H
• Kim HJ
• Joo MK
• Lee BJ
• Park JJ
• Kim JS
• Bak YT

• KMID: 2448531
• DOI: http://doi.org/10.15279/kpba.2016.21.3.163

Abstract

Advances in imaging modalities have provided useful information in diagnosing ampullary lesions such as adenoma and adenocarcinoma. Endoscopic retrograde cholangiopancreaticography (ERCP) have a role in the diagnosis of unexposed intra-ampullarylesion. We report an interesting case of adenocarinoma of the ampulla of Vater presenting as idiopathic recurrent pancreatitis. A 56 years old woman was referred due to idiopathic recurrent pancreatitis for 2 years. She presented abdominal pain and upper abdominal tenderness. Magnetic resonance cholangiopancreaticography (MRCP) revealed minimal bile and pancreatic ductal dilatation without obstruction. Subsequent ERCP revealed a small polypoid lesion which was exposed after endoscopic sphincterotomy. Endoscopic biopsy showed papillary adenoma with low grade dysplasia. Additional endoscopic papillectomy was performed. Endoscopic biopsy done 3 months later showed papillary adenoma with high grade dysplasia. Pylorus preserving pancreatoduodenectomy was done and final pathology was well differentiated adenocarcinoma. The patient was recovered well but received adjuvant chemotherapy due to metastatic lymph nodes.

Keyword

Idiopathic recurrent pancreatitis; Adenocarcinoma of ampulla of vater

MeSH Terms

Abdominal Pain
Adenocarcinoma*
Adenoma
Ampulla of Vater
Bile
Biopsy
Chemotherapy, Adjuvant
Cholangiopancreatography, Endoscopic Retrograde
Diagnosis
Dilatation
Female
Humans
Lymph Nodes
Pancreatic Ducts
Pancreaticoduodenectomy
Pancreatitis*
Pathology
Pylorus
Sphincterotomy, Endoscopic