Squamous cell carcinoma of the ampulla of vater – A case report

A. Rajapakse; E. Malewana; J. Jayasinghe; B. Kailasapathy; A. Pathirana; I. Prematilleke

Authors

A. Rajapakse Faculty of Medical Sciences, University of Sri Jayewardenepura
E. Malewana Faculty of Medical Sciences, University of Sri Jayewardenepura
J. Jayasinghe Colombo South Teaching Hospital
B. Kailasapathy Faculty of Medical Sciences, University of Sri Jayewardenepura
A. Pathirana Faculty of Medical Sciences, University of Sri Jayewardenepura
I. Prematilleke Faculty of Medical Sciences, University of Sri Jayewardenepura

Abstract

Introduction: Ampullary carcinoma comprises up to 2% of all gastrointestinal malignancies. Primary squamous cell carcinoma of the ampulla is a very rare neoplasm, with only three reported cases in literature. Due to its rarity, the biological behavior is largely unknown. We highlight such a case, and its diagnostic workup.

Case Report: A 61 year old woman presented with painless obstructive jaundice of 2 months duration. MRI scan showed a stricture in the distal common bile duct suggestive of a neoplasm. Biopsy at ERCP showed a poorly differentiated ampullary carcinoma. The specimen received at Whipple’s surgery showed a white tumour surrounding the ampulla, 25 mm in maximum dimension. Histology and immunohistochemistry (CK 7+/20 -, CA 19-9+, CK5/6 focally+) pointed towards a poorly differentiated squamous cell carcinoma. A primary squamous carcinoma elsewhere was excluded. The patient is alive nine months after surgery.

Discussion: Ampullary squamous cell carcinoma is most often metastatic from sites such as the larynx, esophagus, lung and uterus. A squamous carcinoma therefore requires ruing out of a primary site elsewhere or a glandular component (adenosquamous carcinoma). These were excluded in this patient. Immunohistochemistry differed from that of primary adenocarcinoma of the ampulla.