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Tjahja M, Tran PP, Binsol PD, Ramirez JC. A Case of Breast Cancer Metastasizing to the Ampulla of Vater. Cureus 2024; 16:e58396. [PMID: 38756323 PMCID: PMC11097995 DOI: 10.7759/cureus.58396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Secondary tumors of the ampulla of Vater are exceedingly rare and associated with relatively poor prognosis. Tumors of the ampulla are classified into four distinct subtypes based on the location and involvement of surrounding structures. Most reported cases are of renal cell or malignant skin melanoma primary with only five previously reported cases of breast primary found in a literature review. We present a 72-year-old woman with metastatic breast cancer to the ampulla of Vater as well as multiple bones. She had a history of breast cancer status post bilateral mastectomy and chemo 27 years prior. She presented to the hospital with altered mental status and was found to have an acute liver injury. Magnetic resonance cholangiopancreatography revealed a distended gallbladder and an indeterminate left retroperitoneal mass concerning for cystic or necrotic lymphadenopathy. Endoscopy then showed an edematous and erythematous periampullary region, which was biopsied and returned positive for carcinoma. Immunohistochemical staining of the retroperitoneal mass returned positive for keratin, estrogen receptor, GATA3, and MOC31 and negative for progesterone receptor, WT1, calretinin, and E-cadherin. The periampullary region's immunohistochemistry returned positive for pankeratin (AE1/AE3) and CD138 and negative for CD45 and S100, supporting a diagnosis of primary breast carcinoma. The average time from diagnosis of breast cancer to metastasis was found to be 2.5 years. Endoscopic visual presentation of metastatic cancer to the ampulla is indistinguishable from that of primary cancers. Thus, a biopsy with cytology and immunohistochemical analysis is necessary for diagnosis. Management of secondary ampullary tumors requires a multidisciplinary team, including gastroenterology, surgery, oncology, and often palliative care. Secondary tumors have been found to be treated by any combination of Whipple's resections, chemotherapy, drainage/stenting, and endoscopic ampullectomy.
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Affiliation(s)
- Matthew Tjahja
- Internal Medicine, Baylor Scott and White Temple Medical Center, Temple, USA
| | - Phi P Tran
- Internal Medicine, Baylor Scott and White Temple Medical Center, Temple, USA
| | | | - Jonathan C Ramirez
- Gastroenterology, Baylor Scott and White Temple Medical Center, Temple, USA
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Hirata T, Kawaguchi S, Akamatsu T, Inagawa A, Hikichi T, Ohkawa K, Asahara K, Satoh T, Endo S, Suzuki M, Ohno K. Duodenal Papillary Metastasis of Lung Cancer with Bleeding Controlled by Endoscopic Treatment and Systemic Osimertinib Therapy: Case Report. Case Rep Gastroenterol 2024; 18:122-128. [PMID: 38476646 PMCID: PMC10932551 DOI: 10.1159/000537778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Solid organ malignancies rarely metastasize to the duodenal papilla. We describe a case of primary lung cancer with duodenal papillary metastasis in a patient who presented with melena. To the best of our knowledge, this is only the second report of duodenal papillary metastasis from lung cancer. Case Presentation A 65-year-old woman presented with complaints of anorexia, weight loss, and black stool. Imaging studies led to a clinical diagnosis of stage IVB lung cancer, and anticoagulants were initiated to treat pulmonary artery thrombosis. However, endoscopic hemostasis was challenging because of bleeding from a duodenal papillary tumor. Fortunately, the patient was positive for the plasma epidermal growth factor receptor (EGFR) gene mutation, and osimertinib, an EGFR tyrosine kinase inhibitor, was administered, successfully achieving hemostasis. Subsequently, endoscopic ultrasonography-guided transbronchial needle aspiration of an enlarged mediastinal lymph node and duodenal papillary tumor biopsy confirmed duodenal papillary metastasis of the primary lung adenocarcinoma. Conclusion Although duodenal papillary metastasis is extremely rare, a good clinical outcome was achieved in this case by considering duodenal papillary metastasis from lung cancer as the differential diagnosis and administering systemic osimertinib therapy.
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Affiliation(s)
- Taiyo Hirata
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Taisuke Akamatsu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Atsuko Inagawa
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomoki Hikichi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kohei Ohkawa
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuhisa Asahara
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tatsunori Satoh
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Shinya Endo
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
| | - Makoto Suzuki
- Department of Pathology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kazuya Ohno
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan
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Clear Cell Renal Cell Carcinoma Metastasized to the Ampulla of Vater 16 Years after Nephrectomy—A Rare Case. Diagnostics (Basel) 2022; 12:diagnostics12030571. [PMID: 35328124 PMCID: PMC8947593 DOI: 10.3390/diagnostics12030571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 12/01/2022] Open
Abstract
Although clear cell renal cell carcinoma (ccRCC) is easy to diagnose early and most can be radically resected, nearly one-third of patients still experience metastases after radical nephrectomy. The most common distant metastases sites of ccRCC are lung, bone and liver. However, periampullary metastasis of ccRCC is very rare and easy to misdiagnose. A 59-year-old male patient was hospitalized for recurrent hematochezia. He had a history of nephrectomy 16 years ago due to ccRCC. Enhanced upper abdominal computed tomography (CT) suggested a mass in the ampulla of vater, and active hemorrhage of duodenal papilla was observed by endoscopy. He underwent an emergency pancreaticoduodenectomy because endoscopic hemostasis and transcatheter arterial embolization (TAE) both failed. Intraoperatively, we found that the tumor located in the ampulla and invaded the pancreatic tissue. The operation was successful, with no postoperative complications. Postoperative pathology suggested metastatic ccRCC.
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Ali J, Khan A, Ahmed MH, Madhotra R. Secondary Tumors of the Ampulla of Vater: A Tale of Two Cases. J Lab Physicians 2022; 13:384-387. [PMID: 34975261 PMCID: PMC8714407 DOI: 10.1055/s-0041-1732810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
We report two cases of women with metastatic cancers to ampulla of Vater. The first was 91 years old and presented with severe anemia, due to upper gastrointestinal bleeding. She had history of renal cell cancer treated with nephrectomy 8 years ago and diagnosis confirmed to be metastasis of renal cell cancer to ampulla of Vater. The second patient was 54 years old with breast cancer, metastasis and developed obstructive jaundice; diagnosis confirmed to be breast metastasis in the ampulla of Vater. Secondary tumors of the ampulla of Vater due to breast cancer and renal cell cancer are rare findings and prognosis can be poor.
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Affiliation(s)
- Jafer Ali
- Department of Gastroenterology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom
| | - Asad Khan
- Department of Gastroenterology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom
| | - Ravi Madhotra
- Department of Gastroenterology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, United Kingdom
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Maji S, Jha JK, Chaturvedi V. Adenosquamous Carcinoma of Ampulla of Vater-a Rare Entity. Indian J Surg Oncol 2021; 12:442-445. [PMID: 34295094 DOI: 10.1007/s13193-021-01327-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 04/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Suvendu Maji
- Department of Surgical Oncology, Medical College, Kolkata, West Bengal India
| | - Jayesh Kumar Jha
- Department of Surgical Oncology, Medical College, Kolkata, West Bengal India
| | - Vikram Chaturvedi
- Department of Surgical Oncology, Medical College, Kolkata, West Bengal India
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Son JH, Lee JS, Kim JW, Kim NH, Kim HS, Lee YS. Ampulla of Vater metastasis from squamous cell carcinoma of the esophagus. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii200040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jun Hyuk Son
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jung Su Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Wook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Nam-Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Han-Seong Kim
- Department of Pathology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yoon Suk Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Tang J, Zhao GX, Deng SS, Xu M. Rare common bile duct metastasis of breast cancer: A case report and literature review. World J Gastrointest Oncol 2021; 13:147-156. [PMID: 33643530 PMCID: PMC7896423 DOI: 10.4251/wjgo.v13.i2.147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/11/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast cancer is the most common tumor in women, and about one-third of cases develop metastatic disease. However, metastatic breast cancer rarely invades the common bile duct (CBD) directly without involving the liver, and involvement of the gastrointestinal tract is rare. Cases of such metastases pose a particular diagnostic challenge.
CASE SUMMARY A 55-year-old female presented to the Department of Gastroenterology with complaint of a 2 mo history of right upper abdominal pain accompanied by pain in the right back, aggravated after eating greasy diet. The patient had received a diagnosis of breast cancer 3 years prior. Physical examination showed obvious superficial protuberant erythema on the left neck and chest skin, with slight tenderness and burning sensation. Endoscopic retrograde cholangiopancre-atography showed an obstruction at the end of the CBD. Histopathology of the CBD and symptomatic skin biopsies showed positivity for cytokeratin 7 and trans-acting T-cell-specific transcription factor breast cancer biomarkers. A cancer embolus was also found in the skin vasculature. Accordingly, the diagnosis of breast cancer metastases to the skin and biliary ducts was made. A plastic biliary sent was placed, which relieved the right upper abdominal pain and protected against unnecessary hepatectomy surgery.
CONCLUSION Although rare, biliary metastasis should be considered in patients with bile duct stenosis and a history of breast cancer.
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Affiliation(s)
- Jie Tang
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Guang-Xi Zhao
- Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Shuang-Shuang Deng
- Department of Pathology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Ming Xu
- Department of Gastroenterology, Pudong New Area People's Hospital, Shanghai University of Medicine & Health Sciences, Shanghai 201200, China
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