Signet ring carcinoma of ampulla of vater
A 61-year-old woman was admitted to the Al Zahra hospital in Isfahan, Iran, in 2011 with occasional jaundice and generalized pruritic for 4 months; also, she complained of 7 kg weight loss during this period. She had no symptoms of nausea, vomiting, or abdominal pain. She had a past history of diabetes mellitus and blood hypertension. Physical examination was not contributory. In initial investigation, the laboratory test results demonstrated the rising level of glutamate-pyruvate transaminase, glutamic-oxaloacetic transaminase, alkaline phosphatase, γ-glutamyl transferase, and mild increase in total bilirubin and direct bilirubin. Ultrasonography indicted extra and intrahepatic biliary duct dilatation and increased common bile duct diameter. At endoscopic retrograde cholangiopancreatography (ERCP), the tumor of papilla of Vater was revealed and dilated intrahepatic and common bile duct with distal rat tailing was shown after dye injection []. Biopsies taken during ERCP were diagnosed as signet ring carcinoma. Subsequence CT scan indicated intra- and extrahepatic ducts dilation, there were no obstructive mass or adenopathy. Liver, spleen, stomach, and pancreas were normal. At last the patient underwent a Whipple resection. On macroscopic examination there was polypoid mass at ampulla of Vater measured about 0.8 × 1 × 1 cm. pancreas and duodenum were normal. On microscopic examination the, malignant epithelial cells had intracytoplasmic mucin and individually infiltrating pattern that invaded to duodenal wall []. Regional lymph nodes were not involved. The ampullary carcinoma was diagnosed as T2N0M0, Stage IB according to the International Union Against cancer TNM classification (UICC).[]