Secondary tumours of the ampulla of Vater: Case report and review of the literature

Sarocchi,Francesca; Gilg,Magdalena  M.; Schreiber,Florian; Langner,Cord

doi:10.3892/mco.2017.1535

Secondary tumours of the ampulla of Vater: Case report and review of the literature

Authors:
- Francesca Sarocchi
- Magdalena M. Gilg
- Florian Schreiber
- Cord Langner
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Affiliations: Institute of Pathology, Medical University of Graz, A-8036 Graz, Austria, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, A-8036 Graz, Austria
Published online on: December 12, 2017 https://doi.org/10.3892/mco.2017.1535
Pages: 274-280
Copyright: © Sarocchi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Secondary tumours of the ampulla of Vater are rare. Underlying primary tumours, clinical presentation, macroscopic appearance, treatment strategies and outcome of secondary ampullary lesions have not been systematically analysed. The present case study reported a 57-year old patient with an ampullary metastasis from renal cancer and a literature review was performed in which a further 32 patients were included. The most common responsible primary tumours were malignant melanoma and renal clear cell carcinoma, followed by breast cancer. The time interval between the diagnosis of the primary tumour and the ampullary metastasis was highly variable, and may be as long as 10 years, particularly for renal cancer. Patients may present with unspecific abdominal discomfort, jaundice or upper gastrointestinal bleeding. The gross appearance was largely indistinguishable from that of a primary tumour. Lesions may present as polypoid or irregular, soft and friable tumour mass, in certain cases with superficial ulceration. In ~50% of cases, the ampullary metastasis was the only metastatic lesion, while in the remaining cases, the cancer had spread to one or more organs. The prognosis was generally poor. The management requires a multi-modal approach, including endoscopic, surgical and oncological procedure.

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1	Horiguchi S and Kamisawa T: Major duodenal papilla and its normal anatomy. Dig Surg. 27:90–93. 2010. View Article : Google Scholar : PubMed/NCBI
2	Adsay V, Ohike N, Tajiri T, Kim GE, Krasinskas A, Balci S, Bagci P, Basturk O, Bandyopadhyay S, Jang KT, et al: Ampullary region carcinomas: Definition and site specific classification with delineation of four clinicopathologically and prognostically distinct subsets in an analysis of 249 cases. Am J Surg Pathol. 36:1592–1608. 2012. View Article : Google Scholar : PubMed/NCBI
3	Perysinakis I, Margaris I and Kouraklis G: Ampullary cancer-a separate clinical entity? Histopathology. 64:759–768. 2014. View Article : Google Scholar : PubMed/NCBI
4	Albores-Saavedra JHR, Klimstra DS and Zamboni G: Invasive adenocarcinoma of the ampullary region 2WHO Classification of Tumours of the Digestive System. Bosman FTCF, Hruban RH and Theise ND: IARC Press; pp. 87–91. 2010
5	Wei SC, Su WC, Chang MC, Chang YT, Wang CY and Wong JM: Incidence, endoscopic morphology and distribution of metastatic lesions in the gastrointestinal tract. J Gastroenterol Hepatol. 22:827–831. 2007. View Article : Google Scholar : PubMed/NCBI
6	England MD and Sarr MG: Metastatic melanoma: An unusual cause of obstructive jaundice. Surgery. 107:595–596. 1990.PubMed/NCBI
7	Sans M, Llach J, Bordas JM, Andreu V, Campo A, Castells A, Mondelo E, Terés J and Rodés J: Metastatic malignant melanoma of the papilla of Vater: An unusual case of obstructive cholestasis treated with biliary prostheses. Endoscopy. 28:791–792. 1996. View Article : Google Scholar : PubMed/NCBI
8	Meyers MO, Frey DJ and Levine EA: Pancreaticoduodenectomy for melanoma metastatic to the duodenum: A case report and review of the literature. Am Surg. 64:1174–1176. 1998.PubMed/NCBI
9	Caballero-Mendoza E, Gallo-Reynoso S, Arista-Nasr J and Angeles-Angeles A: Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of vater. J Clin Gastroenterol. 29:188–189. 1999. View Article : Google Scholar : PubMed/NCBI
10	Le Borgne J, Partensky C, Glemain P, Dupas B and de Kerviller B: Pancreaticoduodenectomy for metastatic ampullary and pancreatic tumors. Hepatogastroenterology. 47:540–544. 2000.PubMed/NCBI
11	van Bokhoven MM, Aarntzen EH and Tan AC: Metastatic melanoma of the common bile duct and ampulla of Vater. Gastrointest Endosc. 63:873–874. 2006. View Article : Google Scholar : PubMed/NCBI
12	Marks JA, Rao AS, Loren D, Witkiewicz A, Mastrangelo MJ and Berger AC: Malignant melanoma presenting as obstructive jaundice secondary to metastasis to the Ampulla of Vater. JOP. 11:173–175. 2010.PubMed/NCBI
13	Uiterwaal MT, Mooi WJ and Van Weyenberg SJ: Metastatic melanoma of the ampulla of Vater. Dig Liver Dis. 43:e82011. View Article : Google Scholar : PubMed/NCBI
14	Nakayama H, Miyazaki S, Kikuchi H, Saito N, Shimada H, Sakai S, Suzuki M and Kimura K: Malignant vaginal melanoma with metastases to the papilla of Vater in a dialysis patient: A case report. Intern Med. 50:345–349. 2011. View Article : Google Scholar : PubMed/NCBI
15	McKenna JI and Kozarek RA: Metastatic hypernephroma to the ampulla of Vater: An unusual cause of malabsorption diagnosed at endoscopic sphincterotomy. Am J Gastroenterol. 84:81–83. 1989.PubMed/NCBI
16	Robertson GS and Gertler SL: Late presentation of metastatic renal cell carcinoma as a bleeding ampullary mass. Gastrointest Endosc. 36:304–306. 1990. View Article : Google Scholar : PubMed/NCBI
17	Venu RP, Rolny P, Geenen JE, Hogan WJ, Komorowski RA and Ferstenberg R: Ampullary tumor caused by metastatic renal cell carcinoma. Dig Dis Sci. 36:376–378. 1991. View Article : Google Scholar : PubMed/NCBI
18	Bolkier M, Ginesin Y, Moskovitz B, Munichor M and Levin DR: Obstructive jaundice caused by metastatic renal cell carcinoma. Eur Urol. 19:87–88. 1991. View Article : Google Scholar : PubMed/NCBI
19	Leslie KA, Tsao JI, Rossi RL and Braasch JW: Metastatic renal cell carcinoma to ampulla of Vater: An unusual lesion amenable to surgical resection. Surgery. 119:349–351. 1996. View Article : Google Scholar : PubMed/NCBI
20	Janzen RM, Ramj AS, Flint JD, Scudamore CH and Yoshida EM: Obscure gastrointestinal bleeding from an ampullary tumour in a patient with a remote history of renal cell carcinoma: A diagnostic conundrum. Can J Gastroenterol. 12:75–78. 1998. View Article : Google Scholar : PubMed/NCBI
21	Mendoza JL, Lana R, Defarges V, Meroño E, Candía A and Loscos JM: Late metastasis of hypernephroma of the Vater's ampulla. Rev Esp Enferm Dig. 93:606–608. 2001.PubMed/NCBI
22	Hata T, Sakata N, Aoki T, Yoshida H, Kanno A, Fujishima F, Motoi F, Masamune A, Shimosegawa T and Unno M: Repeated pancreatectomy for metachronous duodenal and pancreatic metastases of renal cell carcinoma. Case Rep Gastroenterol. 7:442–448. 2013. View Article : Google Scholar : PubMed/NCBI
23	Titus AS, Baron TH, Listinsky CM and Vickers SM: Solitary breast metastasis to the ampulla and distal common bile duct. Am Surg. 63:512–515. 1997.PubMed/NCBI
24	Rego RF, Atiq M, Velchala N, Nevin D, McElreath DP, McKnight WD and Aduli F: Ampullary metastasis from breast cancer: An unusual finding. Endoscopy. 41 Suppl 2:E278–E279. 2009. View Article : Google Scholar : PubMed/NCBI
25	Lee TH, Park SH, Lee CK, Lee SH, Chung IK, Kim SJ and Kim SW: Ampulla of Vater metastasis from recurrent uterine cervix carcinoma presenting as groove pancreatitis. Gastrointest Endosc. 73:362–363. 2011. View Article : Google Scholar : PubMed/NCBI
26	Sreenarasimhaiah J and Hoang MP: Esophageal squamous cell carcinoma with metastasis to the ampulla. Gastrointest Endosc. 62:310–311, discussion 311. 2005. View Article : Google Scholar : PubMed/NCBI
27	Büyükçelik A, Ensari A, Sarioğlu M, Işikdogan A and Içli F: Squamous cell carcinoma of the larynx metastasized to the ampulla of Vater. Report of a case. Tumori. 89:199–201. 2003.PubMed/NCBI
28	Kamusella P, Wissgott C and Steinkamp HJ: [Extrahepatic biliary obstruction caused by papillary metastasis of pulmonary adenocarcinoma]. RoFo Fortschr Geb Rontgenstr Nuklearmed. 179:1272–1273. 2007. View Article : Google Scholar : PubMed/NCBI
29	Silva R, Paiva ME and Santos CC: Obstructive jaundice caused by ampullary metastases of an endometrioid adenocarcinoma. Gastrointest Endosc. 44:195–197. 1996. View Article : Google Scholar : PubMed/NCBI
30	Green D, Rowsell C and Cohen L: Metastatic bladder carcinoma to ampulla of Vater. Gastrointest Endosc. 68:199–200. 2008. View Article : Google Scholar : PubMed/NCBI
31	Kadakia SCPA, Parker A and Canales L: Metastatic tumors to the upper gastrointestinal tract: Endoscopic experience. Am J Gastroenterol. 87:1418–1423. 1992.PubMed/NCBI
32	Haidong W, Jianwei W, Guizhong L, Ning L, Feng H and Libo M: Ampullary tumor caused by metastatic renal cell carcinoma and literature review. Urol J. 11:1504–1507. 2014.PubMed/NCBI
33	Bastos T, Souza TF, Otoch JP, Grecco E, Àvila F and Artifon EL: Metastasis of breast cancer to major duodenal papilla. Rev Gastroenterol Peru. 34:149–150. 2014.PubMed/NCBI
34	Buissin D, Sterle A, Schmiegelow P, Wassenberg D and Ambe PC: Primary anorectal malignant melanoma: a rare but aggressive tumor: report of a case. World J Surg Oncol. 13:122015. View Article : Google Scholar : PubMed/NCBI
35	Weigt J and Malfertheiner P: Metastatic Disease in the Stomach. Gastrointest Tumors. 2:61–64. 2015. View Article : Google Scholar : PubMed/NCBI
36	Ito K, Fujita N, Noda Y, Kobayashi G and Horaguchi J: Diagnosis of ampullary cancer. Dig Surg. 27:115–118. 2010. View Article : Google Scholar : PubMed/NCBI
37	Wiech T, Walch A and Werner M: Histopathological classification of nonneoplastic and neoplastic gastrointestinal submucosal lesions. Endoscopy. 37:630–634. 2005. View Article : Google Scholar : PubMed/NCBI
38	Ceppa EP, Burbridge RA, Rialon KL, Omotosho PA, Emick D, Jowell PS, Branch MS and Pappas TN: Endoscopic versus surgical ampullectomy: An algorithm to treat disease of the ampulla of Vater. Ann Surg. 257:315–322. 2013. View Article : Google Scholar : PubMed/NCBI
39	De Palma GD, Masone S, Rega M, Simeoli I, Donisi M, Addeo P, Iannone L, Pilone V and Persico G: Metastatic tumors to the stomach: Clinical and endoscopic features. World J Gastroenterol. 12:7326–7328. 2006. View Article : Google Scholar : PubMed/NCBI
40	Pollheimer MJ, Hinterleitner TA, Pollheimer VS, Schlemmer A and Langner C: Renal cell carcinoma metastatic to the stomach: Single-centre experience and literature review. BJU Int. 102:315–319. 2008. View Article : Google Scholar : PubMed/NCBI
41	Leibovich BCCJ, Cheville JC, Lohse CM, Zincke H, Frank I, Kwon ED, Merchan JR and Blute ML: A scoring algorithm to predict survival for patients with metastatic clear cell renal cell carcinoma: A stratification tool for prospective clinical trials. J Urol. 174:1759–1763, discussion 1763. 2005. View Article : Google Scholar : PubMed/NCBI
42	Hornick JR, Johnston FM, Simon PO, Younkin M, Chamberlin M, Mitchem JB, Azar RR, Linehan DC, Strasberg SM, Edmundowicz SA, et al: A single-institution review of 157 patients presenting with benign and malignant tumors of the ampulla of Vater: Management and outcomes. Surgery. 150:169–176. 2011. View Article : Google Scholar : PubMed/NCBI
43	Klein F, Jacob D, Bahra M, Pelzer U, Puhl G, Krannich A, Andreou A, Gül S and Guckelberger O: Prognostic factors for long-term survival in patients with ampullary carcinoma: The results of a 15-year observation period after pancreaticoduodenectomy. HPB Surg. 2014:9702342014. View Article : Google Scholar : PubMed/NCBI