Rossaak Jeremy, Bagshaw Philip, Connor Saxon
Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand.
Case Rep Gastroenterol. 2008 Mar 13;2(1):96-102. doi: 10.1159/000119321.
Duodenal adenomas are uncommon, however, when present a proportion have dysplasia associated with the adenoma and therefore require treatment. The options range from less invasive endoscopic treatments to a pancreaticoduodenectomy. This case report describes two patients with adenomas involving the ampulla of Vater. One patient had familial adenomatous polyposis, the other was a renal transplant patient with a large adenoma. Both patients' adenomas contained high-grade dysplasia. Both patients underwent a pancreaticoduodenectomy. Histology of both specimens demonstrated that the adenoma had migrated up the bile duct for at least 7 mm, and the pancreatic duct for 8 mm in one patient. Limited resection of ampullary adenomas may leave residual adenomatous tissue in the bile duct with the risk of recurrent adenomatous disease and malignant transformation.
十二指肠腺瘤并不常见，然而，一旦出现，部分腺瘤会伴有发育异常，因此需要治疗。治疗选择范围从侵入性较小的内镜治疗到胰十二指肠切除术。本病例报告描述了两名患有累及十二指肠乳头腺瘤的患者。一名患者患有家族性腺瘤性息肉病，另一名是患有大腺瘤的肾移植患者。两名患者的腺瘤均含有高级别发育异常。两名患者均接受了胰十二指肠切除术。两个标本的组织学检查均显示，腺瘤在一名患者中已沿胆管向上迁移至少7毫米，沿胰管向上迁移8毫米。壶腹腺瘤的有限切除可能会在胆管中留下残留的腺瘤组织，存在腺瘤性疾病复发和恶变的风险。
