THE CONCURRENCE OF CARCINOID TUMOR IN ADENOMA OF THE AMPULLA VATER AND AN EARLY ESOPHAGEAL CANCER

A 69-year-old man was admitted to the department for operation with a diagnosis of early esophageal cancer and adenoma of the ampulla of Vater that was revealed by upper GI series with biopsies at medical checkup. The tumor of the ampulla of Vater was diagnosed with adenoma and no remnant tumor in the resected stumps was confirmed by intraoperative frozen section diagnosis, the operative procedures comprised local resection of the ampulla of Vater, sphincteroplasty and nonthorocotomic esophagectomy. Histopathologically, the resected specimen of the papilla showed adenoma with moderately-severe atypia and just partially disclosed carcinoid (2mm) in adenoma. Cancer change of adenomas of the ampulla of Vater occurs in a high frequenty and we have difficulty in the treatment. Previous cases of cancer in adenoma of the ampulla of Vater have been performed pancreatoduodenectomy (PD) and no local lymph node involvement has been reported in all cases. So, it is thought that local resection can be indicated, if no remnant tumor in the resected stumps is confirmed by intraoperative frozen section diagnosis.