Iwashita Yuji, Ito Kei, Noda Yutaka, Koshita Shinsuke, Kanno Yoshihide, Ogawa Takahisa, Masu Kaori, Michikawa Yosuke
Department of Gastroenterology, Sendai City Medical Center, Sendai, Miyagi, Japan.
Am J Case Rep. 2015 Sep 1;16:586-9. doi: 10.12659/AJCR.894014.
Although ampullary adenomas have been reported to be considered as precancerous lesions, there have been very few reports of cases in which cancer occurred after long-term follow-up. We herein report a case of ampullary adenoma that developed to cancer after long-term observation.
An 81-year-old man was referred to our hospital due to a tumor at the ampulla of Vater. Histological examination revealed a tubular adenoma. Because the patient refused treatment, follow-up by duodenoscopy, EUS, MRCP, and forceps biopsy was planned. There was no change in the tumor for 6 years. Seven years after the initial diagnosis, he developed from jaundice. Duodenoscopy showed an easy-bleeding, reddish, uneven surface area of the tumor and NBI demonstrated an irregular, non-structured surface pattern. EUS demonstrated invasion of the duodenal muscularis and infiltration into the bile duct. Histological examination revealed a well-differentiated adenocarcinoma.
The clinical course of this case provides evidence of the adenoma-carcinoma sequence.
尽管壶腹腺瘤被认为是癌前病变，但长期随访后发生癌变的病例报道极少。我们在此报告一例壶腹腺瘤经长期观察后发展为癌的病例。
一名81岁男性因 Vater 壶腹肿瘤转诊至我院。组织学检查显示为管状腺瘤。由于患者拒绝治疗，计划通过十二指肠镜检查、超声内镜检查（EUS）、磁共振胰胆管造影（MRCP）和钳取活检进行随访。6年来肿瘤无变化。初始诊断7年后，他出现黄疸。十二指肠镜检查显示肿瘤表面易出血、发红且不平整，窄带成像（NBI）显示表面形态不规则、无结构。超声内镜检查显示十二指肠肌层受侵并浸润至胆管。组织学检查显示为高分化腺癌。
该病例的临床病程为腺瘤-癌序列提供了证据。
