Usuda Atsuho, Shiozawa Shunichi, Tsuchiya Ahira, Kim Dal Ho, Usui Takebumi, Inose Satoshi, Aizawa Masaki, Masuda Toshio, Yoshimatsu Kazuhiko, Watanabe Osamu, Katsube Takao, Naritaka Yoshihiho, Ogawa Kenji
Department of Surgery, Tokyo Women's Medical University Medical Center East, Japan.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1542-4.
The present paper reported a case of a carcinoma that probably developed from the peribiliary gland within the ampulla of Vater based on the histopathological findings of the resected specimens. A 49-year-old female became aware of epigastralgia and was diagnosis of stenosis of duodenal 2nd portion. There were no malignant findings on gastrointestinal endoscopy and computed thomography. Endoscopic retrograde cholangiopancreatography revealed no tumor in the main pancreatic duct or the common bile duct or ampulla of Vater. Pylorus preserving panctreaticoduodenectomy was performed with a diagnosis of duodenal stenosis of unknown cause. The histopathological findings revealed that a moderately to poorly differentiated adenocarcinoma originating near the peribiliary gland in the ampulla of Vater was extensively distributed in the submucosal layer of the duodenum. Based on these findings, a diagnosis of a carcinoma of the ampulla of Vater arising from the peribiliary gland was most likely suspected. Judging from the generally known development and extension of carcinoma of the ampulla of Vater, the current case appeared to be a very rare one.
本文基于切除标本的组织病理学发现，报告了一例可能起源于 Vater 壶腹周围腺体的癌。一名49岁女性出现上腹部疼痛，被诊断为十二指肠第二部狭窄。胃肠内镜检查和计算机断层扫描未发现恶性病变。内镜逆行胰胆管造影显示主胰管、胆总管或 Vater 壶腹无肿瘤。因诊断为不明原因的十二指肠狭窄，遂行保留幽门的胰十二指肠切除术。组织病理学发现显示，起源于 Vater 壶腹周围腺体附近的中分化至低分化腺癌广泛分布于十二指肠黏膜下层。基于这些发现，最有可能怀疑是起源于周围腺体的 Vater 壶腹癌。从 Vater 壶腹癌的一般已知发展和扩散情况来看，当前病例似乎非常罕见。
