Ampullary Adenocarcinoma: a Mini-Review and a Case Report of a Clinically Stable Disease Patient Treated with Herbal Sup
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CASE REPORT
Ampullary Adenocarcinoma: a Mini-Review and a Case Report of a Clinically Stable Disease Patient Treated with Herbal Supplements Khin Maung Lwin 1 & Ye Htut Linn 2
&
Yamin Kyaw Swar Dee 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Introduction The ampulla of Vater is situated where the common bile duct (CBD) merges with the pancreatic duct and exits into the duodenum. The portion is lined by the columnar epithelium which is similar to that of the lower CBD. Ampullary carcinoma (AC) is a rare malignant tumour originating from the ampulla of Vater and it accounts for approximately 0.2% of all gastrointestinal tract malignancies [1]. Among the 2564 periampullary adenocarcinoma patients who had undergone pancreaticoduodenectomy (PD), AC is the second commonest (accounting for about 11–16%), preceded by carcinoma of the head of the pancreas (HOP)/duct which takes about 66% [2, 3]. According to the data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, there were 5625 cases of AC between 1973 and 2005, and this has been increasing since 1973 [4]. In Burgundy, France, age-standardized incidence rates were 0.46 and 0.30 per 100,000 inhabitants for men and women respectively based on the 34-year data. The incidence rate increased from 0.26 (1976–1984) to 0.58 (2003–2009) for men and remained stable for women [5]. Metabolic diseases such as diabetes, gall stone, chronic pancreatitis, * Ye Htut Linn [email protected] Khin Maung Lwin [email protected] Yamin Kyaw Swar Dee [email protected] 1
FAME Pharmaceuticals Industry Co., Ltd., FAME Clinic, Yangon, Myanmar
2
Research and Development Department, FAME Pharmaceuticals Industry Co., Ltd., Yangon, Myanmar
high total cholesterol, low high-density lipoprotein, and low apolipoprotein A were found to be significantly related to ampullary cancer [6].
Clinical Presentation Due to its anatomical site, AC usually presents earlier with biliary tract obstruction resulting in progressive jaundice. Jaundice may be fluctuating due to the temporary relief of bile obstruction from necrosis of this lesion. Other features of obstructive jaundice such as dark-coloured urine, pale-coloured stool, and pruritus may also occur. Abdominal pain, dyspepsia, pancreatitis (due to obstruction of the pancreatic duct), upper GI bleeding and heme-positive stools (due to ulceration of ampullary mass), and Courvoisier gallbladder may be the presenting signs and symptoms. Also, anorexia, weight loss, and anaemia of chronic disease are associated features of malignancy [1, 7].
Diagnosis Abdominal ultrasonography (USG) is a useful baseline investigation for patients with clinical suspicion of hepatobiliary cancers. Dilatation of bile ducts indicates extrahepatic obstruction. Even if ultrasonography demonstrates normal common bile duct, 10–15% of patients will have extrahepatic biliary obstruction on computed tomography (CT) scan. USG can also be used to reveal metastatic diseases or regional lymph nodes
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