Takahashi Koji, Yamamoto Kenjiro, Aihara Takanori, Ohno Izumi, Ohyama Hiroshi
Gastroenterology, Chiba University, Chiba, JPN.
Medical Oncology, Chiba University, Chiba, JPN.
Cureus. 2025 Mar 27;17(3):e81318. doi: 10.7759/cureus.81318. eCollection 2025 Mar.
Ampullary adenomas are precancerous lesions with a high risk of malignant transformation. Endoscopic papillectomy is the standard treatment, but the presence of adjacent cystic lesions poses a technical challenge. An 83-year-old man underwent an endoscopic examination, which revealed an ampullary tumor adjacent to a cystic lesion. Endoscopic ultrasound and MRI confirmed its cystic nature. A biopsy diagnosed an intestinal-type adenoma. The patient underwent en bloc endoscopic papillectomy with simultaneous resection of the cystic lesion. The procedure was complication free, and histopathological analysis confirmed a nonmalignant adenoma with negative resection margins. The cystic lesion was identified as a dilated glandular duct without adenomatous components. This case underscores the importance of detailed imaging for preoperative planning. En bloc endoscopic papillectomy is a feasible and safe approach for ampullary adenomas with adjacent cystic lesions. A thorough preoperative assessment and meticulous procedural planning are crucial for achieving complete resection with negative margins.
壶腹腺瘤是具有高恶性转化风险的癌前病变。内镜下乳头切除术是标准治疗方法，但相邻囊性病变的存在带来了技术挑战。一名83岁男性接受了内镜检查，发现一个与囊性病变相邻的壶腹肿瘤。内镜超声和磁共振成像证实了其囊性性质。活检诊断为肠型腺瘤。患者接受了整块内镜乳头切除术并同时切除了囊性病变。该手术无并发症，组织病理学分析证实为非恶性腺瘤，切缘阴性。囊性病变被确定为无腺瘤成分的扩张腺管。该病例强调了详细影像学检查对术前规划的重要性。整块内镜乳头切除术对于伴有相邻囊性病变的壶腹腺瘤是一种可行且安全的方法。全面的术前评估和细致的手术规划对于实现切缘阴性的完整切除至关重要。
