Case Reports
Squamous cell carcinoma of the ampullary region; the pitfalls and challenges in diagnosis
Authors:
I. Prematilleke,
University of Sri Jayewardenepura, LK
About I.
Department of Pathology, Faculty of Medical Sciences
M. Gunawardena ,
University of Sri Jayewardenepura, LK
About M.
Department of Pathology, Faculty of Medical Sciences
A. Ranasinghe,
University of Sri Jayewardenepura, LK
About A.
Department of Pathology, Faculty of Medical Sciences
S. Gunasiri,
University of Sri Jayewardenepura, LK
About S.
Department of Pathology, Faculty of Medical Sciences
A. Rajapakse
University of Sri Jayewardenepura, LK
About A.
Department of Pathology, Faculty of Medical Sciences
Abstract
Introduction: Primary squamous cell carcinoma (SCC) of the ampulla of Vater is a very rare entity with only twelve reported cases to date.
Case report: A 61-year-old woman presented with painless obstructive jaundice of six weeks duration. On examination, she was deeply icteric and had tenderness over the right upper quadrant. Her liver enzyme levels were high. Imaging showed an ampullary mass associated with a dilated common bile duct (CBD) and a distal CBD stricture. The biopsy was reported as a poorly differentiated carcinoma. A Whipple procedure was done, and a tan-white, irregular tumour measuring 25x24x20 mm was seen centred on the ampulla. The entire tumour was submitted for histology, which comprised invasive clusters and sheets of malignant squamous cells. There was no adenocarcinoma component in the entire tumour. Special stains for mucin were negative. Immunohistochemistry showed that the tumour cells were strongly positive for CK7 and CA 19-9, focally positive for CK5/6 and negative for CK20. The features were compatble with a SCC of the ampulla. As pure SCC of the ampulla is rare, metastatic involvement of the ampulla was excluded clinically and radiologically.
Discussion and conclusionn: Due to rarity, the prognosis and biological behaviour of this type of carcinoma is largely unknown. Surgery is considered the mainstay of treatment. The possibility of adenosquamous carcinoma and metastasis from other sites should be excluded before making the diagnosis of primary SCC of the ampulla.
How to Cite:
Prematilleke, I., Gunawardena, M., Ranasinghe, A., Gunasiri, S. and Rajapakse, A., 2022. Squamous cell carcinoma of the ampullary region; the pitfalls and challenges in diagnosis. Journal of Diagnostic Pathology, 17(1), pp.26–32. DOI: http://doi.org/10.4038/jdp.v17i1.7818
Published on
31 Dec 2022.
Peer Reviewed
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