Adenosquamous Carcinoma of the Ampulla of Vater: A Rare Cause of Obstructive Jaundice

Tumour markers CA19.9 and CEA were normal. Endoscopic ultrasound was performed using a linear scope and showed a subepithelial mass of the papilla (Fig. 1), corresponding to a hypoechogenic lesion of 22 mm, with submucosal growth, involving the muscularis propria of the duodenum (T2) (Fig. 2). This lesion caused marked dilation of the proximal common bile duct and intrahepatic ducts. A perilesional adenopathy was identified (N1). Endoscopic ultrasound-guided fine needle aspiration (EUSFNA) was performed using a 25-gauge needle and cytologic evaluation was consistent with adenocarcinoma. Computed tomography ruled out distant metastasis and the patient was referred for surgery (cephalic duodenopancreatectomy). Histological analysis of the surgical specimen documented an adenosquamous carcinoma of the ampulla of Vater (ASC AV; Fig. 3), involving the duodenal muscularis propria, with one regional lymph node metastasis (R0, pT2N1). Postoperative outcome was uneventful and the patient remains asymptomatic after a 10-month follow-up period. Adenocarcinomas account for most primary malignant tumors of the ampulla of Vater, while other histological types such as squamous or adenosquamous carcinomas are exceedingly rare [1]. Duodenoscopy in combi