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.