Hakoda Hiroyuki, Kawaguchi Yoshikuni, Miyata Yoichi, Togashi Junichi, Nagai Motoki, Suzuki Yoshio, Nomura Yukihiro
Department of Surgery, Asahi General Hospital, Chiba, Japan.
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Case Rep Gastroenterol. 2024 Mar 18;18(1):129-135. doi: 10.1159/000537900. eCollection 2024 Jan-Dec.
Adenosquamous carcinoma (ASC) of the ampulla of Vater (AmV) is rare. The prognosis is generally worse in patients undergoing resection of ASC of the AmV than in those undergoing resection of adenocarcinoma of the AmV because the former shows early recurrence after surgery. A treatment strategy for ASC of the AmV has not been established, and the efficacy of adjuvant chemotherapy after curative resection is unclear. Given the paucity of data, we report a case of ASC of the AmV that was curatively resected and treated with adjuvant chemotherapy.
A 66-year-old man presented with pruritus and anorexia. Contrast-enhanced computed tomography revealed a tumor measuring 1.6 cm in diameter located at the AmV and distal bile duct. Biopsy revealed adenocarcinoma of the AmV. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination contradictorily revealed ASC of the AmV and lymph node metastases. The postoperative course of the patient was uneventful, and he was discharged on day 25. The patient underwent S-1 adjuvant chemotherapy for 6 months and did not exhibit any postoperative recurrence for a follow-up duration of 28 months.
Although treatment strategy for ASC of the AmV has not been established, our case shows that surgery followed by S-1 adjuvant chemotherapy could improve prognosis of patients with such tumors. However, further research is required to determine the efficacy of adjuvant chemotherapy and treatment strategies for resectable ASC of the AmV.
壶腹周围腺癌（ASC）罕见。相比于壶腹周围腺癌切除术患者，壶腹周围腺鳞癌（AmV）切除术患者的预后通常更差，因为前者术后早期复发。AmV的ASC治疗策略尚未确立，根治性切除术后辅助化疗的疗效尚不清楚。鉴于数据有限，我们报告一例经根治性切除并接受辅助化疗的AmV的ASC病例。
一名66岁男性出现瘙痒和厌食症状。增强计算机断层扫描显示，在AmV和远端胆管处有一个直径1.6厘米的肿瘤。活检显示为AmV腺癌。患者接受了保留胃的胰十二指肠次全切除术。组织病理学检查结果矛盾，显示为AmV的ASC和淋巴结转移。患者术后恢复顺利，于第25天出院。患者接受了6个月的S-1辅助化疗，在28个月的随访期内未出现任何术后复发。
虽然AmV的ASC治疗策略尚未确立，但我们的病例表明，手术联合S-1辅助化疗可改善此类肿瘤患者的预后。然而，需要进一步研究以确定辅助化疗的疗效和可切除AmV的ASC的治疗策略。
