Signet-ring cell carcinoma of the ampulla of Vater

Carcinomas of the ampulla of Vater are uncommon, and signet-ring cell carcinoma is rare. We report a case of signet-ring cell carcinoma of the ampulla of Vater with obstructive jaundice in a 53-year-old man. Abdominal ultrasonography and abdominal computed tomographic scan revealed dilatation of the common bile duct, intrahepatic duct, and main pancreatic duct, with the obstruction level in the distal common bile duct near the ampulla of Vater. Duodenoscopy displayed an ampullary tumor protruding from the papilla of Vater with an erythematous and sloughing surface. Endoscopic biopsy of the tumor showed a signet-ring cell carcinoma. The patient received percutaneous transhepatic cholangiographic drainage, and the jaundice gradually improved. A Whipple operation including pancreatoduodenectomy and hemigastrectomy was performed. Pathological examination confirmed signet-ring cell carcinoma of the ampulla of Vater with direct invasion of the periampullary duodenum and distal common bile duct. No gastric lesion or nodal metastasis was found. The postoperative course was uneventful. The patient was alive with no recurrent disease during a follow-up period of 25 months.