Núñez JC, Rivera MT, Stevens MA. Adenocarcinoma of the duodenal papilla with synchronous peritoneal metastases-5 years of overall survival: A case report. World J Clin Oncol 2025; 16(4): 103651 [DOI: 10.5306/wjco.v16.i4.103651]
Corresponding Author of This Article
Julio César Núñez, Department of Surgery, Hospital del Salvador, No. 364 Salvador Avenue, Providencia, Región Metropolitana de Santiago, Santiago 7500922, Región Metropolitana, Chile. dr.julio.nunez@gmail.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Oncol. Apr 24, 2025; 16(4): 103651 Published online Apr 24, 2025. doi: 10.5306/wjco.v16.i4.103651
Adenocarcinoma of the duodenal papilla with synchronous peritoneal metastases-5 years of overall survival: A case report
Julio César Núñez, María Teresa Rivera, Mary Ann Stevens
Julio César Núñez, Department of Surgery, Hospital del Salvador, Santiago 7500922, Región Metropolitana, Chile
Julio César Núñez, Department of Surgery, Clínica Dávila-Vespucio, Santiago 8241479, Región Metropolitana, Chile
María Teresa Rivera, Department of Anatomic Pathology, Hospital del Salvador, Santiago 7500922, Región Metropolitana, Chile
Mary Ann Stevens, Department of Medical Oncology, Hospital del Salvador, Santiago 7500922, Región Metropolitana, Chile
Mary Ann Stevens, Department of Medical Oncology, Clínica Alemana, Santiago 7650568, Región Metropolitana, Chile
Author contributions: Núñez JC made substantial contributions to the conception and design of the study, and to the acquisition, analysis, and interpretation of the data; wrote the main draft of the article; made critical revisions related to the important intellectual content of the manuscript; authorized and approved the final version of the manuscript; and performed the main clinical and surgical activities; Rivera MT made substantial contributions to the conception and design of the study, and acquisition, analysis, and interpretation of the data; participated in critical revisions related to the important intellectual content of the manuscript; approved the final version of the manuscript; and participated in the anatomopathological analyses and interpretation of the patient samples; Stevens MA made contributions to the conception of the study, interpretation of the data, and critical revisions related to the intellectual content of the manuscript; provided approval of the final version of the manuscript; and participated in the main care of the patient.
Informed consent statement: Informed written consent was obtained from the patient and her parents for the publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Julio César Núñez, Department of Surgery, Hospital del Salvador, No. 364 Salvador Avenue, Providencia, Región Metropolitana de Santiago, Santiago 7500922, Región Metropolitana, Chile. dr.julio.nunez@gmail.com
Received: November 26, 2024 Revised: December 20, 2024 Accepted: February 8, 2025 Published online: April 24, 2025 Processing time: 120 Days and 13.9 Hours
Abstract
BACKGROUND
Ampullary adenocarcinomas are a rare disease. They can be classified anatomically or according to their histology into intestinal, pancreatobiliary, and mixed subtypes, with different subtypes having distinct prognoses and potential treatments. We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater, with predominantly intestinal histology, associated with an isolated and synchronous peritoneal carcinomatosis. It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases, with long-term survival.
CASE SUMMARY
A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium. Images revealed dilatation of the biliary tract and the duct of Wirsung, without a clear obstructive factor. Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla. Biopsies confirmed an adenocarcinoma. In the first surgical step, a biliodigestive bypass was performed in association with resection of the carcinomatosis. Peritoneal metastases was found during the intraoperative period. Subsequently, chemotherapy with the folinic acid, fluorouracil, and oxaliplatin regimen was administered based on histology, and a favorable response was achieved. After a multidisciplinary discussion, the Whipple procedure was performed. A delayed biopsy showed disease-free margins. The patient achieved 5 years of overall survival in August 2024, and 4 years of disease-free survival in September 2024.
CONCLUSION
We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
Core Tip: Ampullary adenocarcinomas are a rare disease. We present a patient with intestinal ampulla adenocarcinoma subtype with synchronic peritoneal metastases resected, and a subsequent favorable response to chemotherapy. He underwent surgery, achieving R0 resection and long-term disease-free survival. Resection of the peritoneal lesion, without the addition of concomitant hyperthermic intraperitoneal chemotherapy, is in accordance with the last evidence about this topic in digestive tumors. Therefore, we do not suggest initially classifying these cases as out of therapeutic reach.
