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Ampullary Tumors - EChin

Ampullary Tumors - EChin - Ampullary Tumors Edward Chin MD...

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Ampullary Tumors Edward Chin, MD February 3, 2005
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Case 87M with scc of mouth S/p R radical neck, partial glossectomy, mandibulectomy, alveoloplasty, flap coverage ’94 2001: elevated LFTs U/S: intra & extrahepatic biliary dilatation, dilated CBD CT: same 2003: CBD stones on U/S, CT EGD ampullary mass, bx’d tubulovillous adenoma w/ foci of high-grade dysplasia
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Case MRCP not feasible (oral hardware) ERCP, EUS declined by patient 2/1/05: N/V, RUQ pain Afebrile, 60/40, 100 RUQ tenderness WBC 19, ALT 87, AST 209, GGT 232, alk phos169, bilirubin 4.6/2.7, amylase/lipase nl CT
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Case CT: ↑↑ dilated CBD (2.6 cm) with stones Dilated intra & extrahepatic ducts Dilated pancreatic duct IVF, antibiotics, ICU GI consult ERCP today
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Ampullary Tumors Periampullary tumors: pancreatic duodenal CBD ampulla 1 o ampullary tumors: Rare: 1 per 6 million Benign & malignant w/ FAP, HNPCC
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Ampulla of Vater Consists of 3 epithelia (CBD, PD, duodenal mucosa) Type I: (70%): formed by union of PD, CBD Type II: (20%) biliopancreatic junction forms close to papilla; short ampulla Type III: CBD & PD enter separately Type IV: BPJ separate from papilla
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