Pedunculated Ampullary Adenoma Recurs as Carcinoma After Ampullectomy

Introduction: Pedunculated ampullary adenoma is a rare periampullary tumor. There is still controversy regarding whether to perform local ampullectomy or radical resection for adenomas with severe dysplasia. Case Description: A 57-year-old man was diagnosed with a large, long pedunculated ampullary tumor arising from the second portion of the duodenum. Histologic examination of the biopsy specimen showed a tubular adenoma with low-grade dysplasia. Laparoscopic transduodenal ampullectomy was conducted, and the tumor was removed surgically with the grossly sufficient free margin. The final histologic examination of the resected tumor showed high-grade dysplasia. Two months later, the mass was found to have recurred and proved to be well-differentiated adenocarcinoma. Finally, the patient underwent pancreaticoduodenectomy. Discussion: Local resection may be acceptable for benign ampullary tumors. However, radical resection should be considered for suspected adenocarcinoma. It comprises a large tumor size, the presence of intraductal extension, and findings of preprocedural high-grade dysplasia. The decision to perform local resection for large tumors should be made carefully because most large tumors are proved to be cancer, and local resection plays a limited role in ampullary cancer. Radical resection should be considered for suspected adenocarcinoma, especially in cases of large tumors or in the presence of preprocedural high-grade dysplasia.