Surgery

Biography

Biography: Roberto Bruno

Abstract

This work aims to report a rare case of metastatic adenocarcinoma presentation of Ampulla of Vater to the right scapula, as fi rst manifestation of systemic metastatic disease. A 45 year-old male patient was diagnosed with adenocarcinoma of the ampullary region, infi ltrating the duodenal wall, pancreas and peri-pancreatic tissue. Th e patient underwent Whipple surgery (pancreatico duodenectomy) for tumor resection. Th e histopathological study has revealed poorly diff erentiated adenocarcinoma with extensive peri-neural infi ltration, vascular invasion with embolization of tumor cells and regional lymph nodes without neoplastic involvement. Four months aft er surgery for resection of ampullary tumor, the patient had severe pain in the right shoulder, which subsequently evolved with the emergence of a suprascapular lump on the same side. It underwent incisional biopsy that revealed adenocarcinoma on the histo-pathological study. It was chosen for tumor resection surgery. During surgery, a link between tumor and bone tissue of the right scapula was observed, leading to the decision to remove the bone fragment to study. The histo-pathological study defi ned the presence of metastatic adenocarcinoma focally for bone tissue, infi ltrating skin, subcutaneous tissue and adjacent muscle. Subsequently, a bone scintigraphy which revealed a heterogeneous hyper-fi xation of the contrast media in the topography of the right scapula (medial edge) was performed. Unfortunately, aft er these events, the patient developed metastatic systemic dissemination, which led to his death. We conclude that this is a presentation of rare and unusual metastatic disease. In our research, it wasn't found any cases of scapula metastasis from Ampulla of Vater adenocarcinoma.