Ampullary micropapillary adenocarcinoma widely metastatic to the lymph nodes: A case report

Abstract

First described in breast cancer, invasive micropapillary carcinoma is being increasingly recognized as an aggressive histological variant of cancers arising from many different organs such as the urinary bladder, the lung, the colorectum, the stomach, the pancreatobiliary system and the salivary glands. Only a few reports exist that focus on the ampullo-pancreatobiliary region.We report a case of a 71 year old man who was admitted with symptoms of obstructive jaundice and slight epigastric pain and weight loss. Clinical and histological investigations revealed a small (<2 cm) ampullary adenocarcinoma comprised of an invasive front showing a micropapillary pattern, mixed with a biliary type solid and cribriform component. Extensive lymphatic and lymph node involvement were present. The widespread lymph node metastases affected both staging categories N and M.We believe micropapillary carcinoma should be considered in the WHO classification of Tumors of the Digestive System, in the ampullary chapter, as a separate histological subtype, in analogy with other organs to reflect its aggressive clinical behavior. Keywords: Micropapillary, Adenocarcinoma, Ampulla