Ampulloma... - Forum

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Ampulloma... - Ärzteforum

Post#1 »

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?


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Surgeon

Re: Ampulloma... - Ärzteforum

Post#2 »

Probably avillous adenoma - same problem as in the bowel though, it has a malignant potential.
Therefore excision - a whipple, is ideal treatment.

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Oncologist

Re: Ampulloma... - Ärzteforum

Post#3 »

Whipple with excellent chance of cure.

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A Doctor

Re: Ampulloma... - Ärzteforum

Post#4 »

I'd await the results of the biopsies. If this is adenocarcinoma, then whipple is necessary and as you know curative in 33% of cases. Chemo & radio-therapy are both pretty useless for this condition. If this an adenoma, then ampullectomy should be curative. Although it's getting to be pretty big, so whipple may be a suitable alternative. Also, if this is an adenoma, the patient should undergo a colonscopy to exclude familial adenomatous polyposis, which which ampullary adenomas are associated.

John Dissector

Re: Ampulloma... - Ärzteforum

Post#5 »

I disagree-- biopsy is a useless and unnecessary step--no matter what the biopsy shows, you must assume carcinoma--a benign biopsy in no way rules out Ca, and the worst thing you could do is an ampullectomy only to find CA on final path--nez pas? Just like a villous adenoma of the rectum or colon or small bowel--a cancer operation must be done--no way to ever assure a totaqlly benign lesion--also remember that the chance of malignancy is directly related to the size of an adenoma, and at this size the chance is in the 75% range, if not higher Ask Ronald Reagan--remember? In 1984 he had a 5cm villous adenoma of the cecum by multiple biopsies showing NO cancer--nonetheless, the docs did a cancer operation by the book, and voila--a Stage II ca--This is a classic board question--don't flub it now!

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Lady Surgeon

Re: Ampulloma... - Ärzteforum

Post#6 »

Quibbling as usual, but a villous adenoma of the rectum can be totally locally excised--it does not require a cancer operation unless the Path from the total transanal excision shows malignancy. Granted, many of these recur post-transanal excision and eventually come to AP resection. In fact, I did an AP resection on one of these that had been repeatedly excised and re-excised at a reputable university medical school. I did the AP because she had about her firfth recurrence and was already incontinent from previous excisions. She had an early invasive cancer and is hopefully cured.

I concur with the Whipple, for Hernan's currently described ampullary lesion.

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