Introduction: Ampullary cancer is a rare form of cancer originated in the ampulla of Vater, accounting for fewer than 1% of cancers related to gastrointestinal tract. The incidence of ampullary cancer is estimated to be approximately 4-10 cases per million population. Obstructive jaundice is the most common presenting symptom, found in 80% of patients. Other nonspecific symptoms include abdominal pain, fever, nausea, dyspepsia, and GI bleeding from tumor sloughing. Here, we’d like to present a case of an advanced ampullary cancer with abdominal pain as the only major symptom on presentation.
Case Description/Methods: 65-year-old female presented with progressively worsening abdominal pain in the epigastric area and bloating for 3 weeks. She also had pale stools during the same period but denied any nausea, vomiting, jaundice, or unintentional weight loss. She is a lifetime non-smoker but uses alcohol occasionally. Initial blood tests were mostly unremarkable except for mildly elevated alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT). Computed tomography (CT) of the abdomen and pelvis revealed 3 liver lesions in addition to common biliary duct dilatation. Based on imaging results, a lesion in the distal common duct or ampulla causing metastatic disease was suspected. She then underwent endoscopic retrograde cholangiopancreatography (ERCP) and had a double pigtail stent placed in the common bile duct. Also, a large fungating mass in the ampulla was discovered and biopsied. Her symptoms resolved after the procedure and was discharged home. A few days later the ampulla mass was reported to be poorly differentiated invasive adenocarcinoma. Her carcinoembryonic antigen (CEA) level at time of diagnosis was 6.5 ng/mL (normal range: 0-2.5 ng/mL).
Discussion: Ampullary cancer is a rare form of malignancy, constituting less than 1% of all gastrointestinal cancers and only 6% of cancers in the periampullary region. Its most common presenting symptom is obstructive jaundice, caused by tumor compression of the distal bile duct. Distinguishing primary ampullary cancer from other periampullary cancers such as cholangiocarcinoma or pancreatic cancer is often difficult. For localized disease, Whipple procedure is the only potentially curative treatment. Due to rarity of the disease, however, there is limited data on treatment choice for advanced ampullary cancer. Combination therapy with gemcitabine and cisplatin appears to confer the best survival advantage.
Disclosures: Jason Chang indicated no relevant financial relationships. MIngwei Yu indicated no relevant financial relationships. Kamila Bakirhan indicated no relevant financial relationships.
Jason Chang, MD, MIngwei Yu, MD, Kamila Bakirhan, MD. P1106 - Ampullary Cancer as an Uncommon Cause of Abdominal Pain, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.