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2.1
Neoplasm of Ampulla of Vater
Tumor of the Ampulla of Vater

Presentation

Most patients with an ectopic pancreas are asymptomatic, and, if present, symptoms are nonspecific and depend on the site of the lesion and the different complications encountered. [ncbi.nlm.nih.gov]

The presenting manifastations include weakness, weight loss, nausea, melena and anaemia. The present case refers to a 65 years old female patient with a GIST of the ampulla of Vater presenting with obstructive jaundice. [jpgmonline.com]

STAV presents a large clinical spectrum mimicking symptoms of adenoma and adenocarcinoma of the ampulla of Vater. [latunisiemedicale.com]

Case presentation The patient was a 61-year-old male who presented to our hospital with increased blood levels of hepatobiliary system enzymes detected during a health check-up. He had a past medical history of hypertension and appendectomy. [surgicalcasereports.springeropen.com]

Gastrointestinal

  • Melena

    The 56-year-old male patient concerned visited our emergency room with melena that started one week prior to hospitalization. The patient was diagnosed to have a tumor in the ampulla of Vater with bleeding on its surface. [ncbi.nlm.nih.gov]

    The silver colored stool is a combination of the white stool of obstructive jaundice combined with black stool of melena or bleeding. It was first described in the British Medical Journal by Dr. H. [en.wikipedia.org]

    The most common manifestations of GIST of the ampulla of Vater include asthenia, weight loss, nausea, melena and anemia. [jpgmonline.com]

    Six patients presented digestive signs: melena in three cases [5,8,9], jaundice in two cases [6,10], abdominal pain in one case and nausea in one case [8]. Three patients complained of weakness and fatigue and two of weight loss. [latunisiemedicale.com]

    Burke and Helwig in a review of 51 cases of GPs reported that the most common symptoms were: abdominal pain, gastrointestinal bleeding, melena, anemia, pyloric obstruction and obstruction of the bile duct [ 1 ]. [hoajonline.com]

Liver, Gall & Pancreas

  • Hepatomegaly

    Hepatomegaly can occur. Rarely, patients present with features of acute pancreatitis or migratory thrombophlebitis. Palpable fixed epigastric masses or supraclavicular nodes are signs of advanced disease and inoperability. [oncology-articles.blogspot.com]

    […] either cause a continuous obstruction or an intermittent obstruction by a ball-valve mechanism thereby causing upper quadrant pain, jaundice and recurrent attacks of pancreatitis. 4 Icterus, evidence of scratch marks all over the body due to pruritus, hepatomegaly [bioline.org.br]

Workup

We highlight such a case, and its diagnostic workup. Case Report: A 61 year old woman presented with painless obstructive jaundice of 2 months duration. MRI scan showed a stricture in the distal common bile duct suggestive of a neoplasm. [journals.sjp.ac.lk]

(ie, for staging purposes) Positron emission tomography (PET) or PET-CT scanning: PET or PET-CT scans can detect metastases that are too small to be reliably detected on a CT scan See Workup for more detail. [emedicine.medscape.com]

Diagnostic workup initially included abdominal computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen which demonstrated dilatation of the common bile duct. [hoajonline.com]

Choledocholithiasis Duodenal Ulcers Gallbladder Cancer Gallbladder Tumors Lymphoma, Non-Hodgkin Pancreatic Cancer Pancreatitis, Chronic Papillary Necrosis Papillary Tumors Other Problems to be Considered: Duodenal carcinoma Adenoma at the ampulla of Vater WORKUP [oncology-articles.blogspot.com]

Treatment

New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer. National Cancer Institute of the United States. National Cancer Institute of Canada. ‎ [books.google.de]

As with other gastrointestinal carcinoid tumors, biological treatment with octreotide analogues can be applied to symptomatic patients. Tumor-targeted radioactive therapy is a newly emerging treatment option. [ncbi.nlm.nih.gov]

Fig. 6A – pre-treatment blood tests Treatment We offered a comprehensive approach to properly manage the pain, improve nutritional status and treat the cancer. [medicorcancer.com]

Surgery (pancreaticoduodenectomy) remains the only treatment modality that offers chance for a cure. [joplink.net]

Prognosis

Tumours that are less than 2 cm or limited to the ampulla appear to have a better prognosis. [ncbi.nlm.nih.gov]

Treatment and prognosis In general, ampullary tumors tend to show a better prognosis than do their biliary or periampullary counterparts as they can be detected at an earlier stage owing to earlier presentation due to biliary obstruction 3. [radiopaedia.org]

NET of the ampulla of Vater has a very similar prognosis to the prognosis of gastroenteropancreatic NET in general, with a 5-year survival rate of approximately 70 % [ 7 ]. [link.springer.com]

 Prognosis better for ampullary carcinomas. [slideshare.net]

Accumulation of p53 protein and the Ki-67 labeling index revealed no significant difference in prognosis. [nature.com]

Etiology

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Definition / general By definition, centered in ampulla of Vater, arises from ampullary intestinal mucosa If advanced, cannot distinguish tumor origin between ampulla, distal common bile duct or pancreas Etiology May arise from villous adenoma or villoglandular [pathologyoutlines.com]

Causes: The etiology of the disease is poorly understood. Patients with familial adenomatous polyposis (FAP) have an increased risk of both benign and malignant ampullary tumors (Burke, 1999). [oncology-articles.blogspot.com]

Epidemiology

  Epidemiology,  Clinical manifestations,  Diagnosis and staging,  Treatment and prognosis. [slideshare.net]

Epidemiology of cholangiocarcinoma: an update focusing on risk factors. Cancer Sci 2010; 101: 579-585 Bosetti C, Bertuccio P, Negri E, et al. Pancreatic cancer: overview of descriptive epidemiology. [sapd.es]

Between 1973 and 2005, 5,625 cases were recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. [emedicine.medscape.com]

One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United States. J Clin Oncol 2008; 26:3063-72. [PMID: 18565894] [pancreas.imedpub.com]

A total of 139 NET of the ampulla of Vater (carcinoids and high-grade neuroendocrine carcinomas) were identified between 1973 and 2006 in a recent analysis of the Surveillance, Epidemiology and End Results Program of the National Cancer Institute [ 1 [link.springer.com]

Pathophysiology

Discussion Abstracts by Overman et al. add to the growing body of evidence that ampullary carcinoma is a pathophysiologically diverse entity. [joplink.net]

Pathophysiology Periampullary carcinoma includes tumors arising in the head, neck, or uncinate process of the pancreas, tumors arising in the distal common bile duct, tumors arising in the duodenum, as well as tumors arising from the ampulla of Vater. [emedicine.medscape.com]

Pathophysiology: Ninety percent of ampullary tumors are adenocarcinomas. Neuroendocrine tumors, cystadenomas, and adenomas represent additional, but uncommon, histologic types. [oncology-articles.blogspot.com]

Prevention

Updated meta-analysis of pancreatic stent placement in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis. World J Gastroenterol 2015;21:7577–83. [link.springer.com]

Because of its location, this cancer can cause obstruction of the common bile duct and prevent bile from flowing into the intestine and out of the body. [medicinenet.com]

[…] through the ampulla: the sphincter of the pancreatic duct, the sphincter of the bile duct, and the sphincter of Oddi. [ citation needed ] The sphincter of Oddi controls the introduction of bile and pancreatic secretions into the duodenum, as well as preventing [en.wikipedia.org]

Prevention A healthful diet, exercise, and avoiding smoking can all help prevent pancreatic cancer and many other diseases. There is no specific way to prevent pancreatic cancer, according to the American Cancer Society. [medicalnewstoday.com]

Read Full Post 3/13/2019 12:00 AM Lifestyle changes that may reduce your risk of cancer Studies reported by the National Institutes of Health have found that at least 75 to 80 percent of cancers in the United States may be prevented by lifestyle changes [cancercenter.com]

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