Female,58 yo, presents with an obstructive jaundice syndrome. No particular pain, important weight loss. USN shows marked dilation of the intra and extrahepatic ducts,no calculi,gallbladder distended with thin wall and many stones. CT Scan shows no hepatic substitutions neither limphnodes in the area. Normal pancreas. ERCP performed this morning showed a polipoid growth on the ampulla of Vater,4x3 cms in diameter. Impossible to cannulate the papilla. 10 biopsies were taken from the surface of the mass. have no path report yet.
We think we are in front of an Ampulloma,very probable of neoplasic nature,mean AdenoCa with no detectable spread.
What would you offer to this patient?