A Case of Undifferentiated Carcinoma of the Duodenal Ampulla of Varter

Carcinoma of the duodenal ampulla of Varter is rare with only four cases reported in Japan. A 58-year-old-man admitted for obstructive jaundice underwent pylorus-preserving pancreatoduodenectomy based on a diagnosis of carcinoma of the duodenal ampulla of Varter (biopsy showing adenocarcinoma) with multiple liver metastasis and lymphnode meastasis confirmed by abdominal enhanced CT, cholangiography, and upper gastrotastestinal endoscopy examination for control of bleeding. The resected speciemen showed undifferentiated carcinoma, an ulcerative mass, t4 (45×35mm), panc3, du3, pn1, n4, A0, PV0, P0, H3, M (-), stage IVb. He died indays after surgery for carcinomatosa. This disease has a poor prognosis in a case like ours because of exceeding stage IIIa on diagnosis for rapid progression and delayed appearance of symptoms. This disease must be detected early and effective chemotherapy implemented to improve prognosis. Our case suggested the tumor originated from intestinal pluripotential stem cells because tumor cells showed epithelial membrane antigen and endocrine granular constitution.