Ampulloma excised - Forum

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bonjorno

Ampulloma excised - Ärzteforum

Post#1 »

As it was decided in Clinical Meeting,the decission about how to approach the lately presented Ampulloma, was to perform a wide local excission through endoscopic approach.

I want to tell you that the 10 biopsies taken from the surface of the tumor,were informed as Adenoma...When the excission took place, it was possible to surround the tumor,measuring 2x3 cms approx., completely with the electrode wire.

Once the tumor was cut,no bleeding took place and bile started to flow

Yet,we had the feeling that the "Adenoma" continued to grow in some small extent, inside the CBD...This, we thought, was a bad sign regarding the nature of the tumor and the whole of it was sent to Path...If there's any sign of malignancy,we'll proceed to perform a Whipple's operation and I personally think that this is the most probable thing that will happen...I'm well aware that 65% of ampullomas measuring more than 2 cms. in diameter are malignant.

P.S. I attach a pic of the excised ampulloma.


bonjorno

Re: Ampulloma excised - Ärzteforum

Post#2 »

Pic

pic.jpg
pic.jpg (15.36 KiB) Viewed 456 times

bonjorno

Re: Ampulloma excised - Ärzteforum

Post#3 »

I received this morning the path's report which I translate literally :

Macroscopic Examination : Nodular structure of villous aspect measuring 2 x 1,5 x 3 cms, of red brownish colour.

Hystological Examination : The sample to be examined corresponds to duodenal mucosa with development of epithelial neoformation constituted by tubular and papillar structures with connective estroma covered by cylindrical, mature, pseudostratified epithelium with no athipies in a estroma with haemorrhage and mixed inflammatory infiltrate.Surgical border section free of neoplasia with signs of electrocoagulation.

Conclusion: Villous Adenoma Totally Excised.

The patient has done well, jaundice went back almost completely,no signs of cholangitis...

Any suggestions?...

What should be done next?

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Oncologist

Re: Ampulloma excised - Ärzteforum

Post#4 »

Villous adenoma of the ampulla of Vater is a rare but distinct pathologic entity, the aggressive nature of these lesions has been well documented, it is a premalignant lesion frequently associated with focal cancer. This adenoma has been treated by a variety of methods, and a consensus for its standard treatment has not been reached.. Their treatment can be either local, endoscopic or surgical, or radical.
With the frequent recurrence when local excision is employed, strong consideration should be given to pancreaticoduodenectomy as the initial form of treatment of these lesions.

I must admit that your endoscopist have done a perfect job, and the diagnosis of focal cancer have been excluded, but we are still left with possibility of recurrence, and in some reports it can occur after 6 years. As I know that you spent some time in France, please read the the following French study it may support my point of view;

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