A 56-year-old woman was admitted with jaundice, and laboratory data were indicative of pancreatitis, which recurred in spite of adequate clinical and nutritional management. The patient was an overweight diabetic using metformin, who had antecedents of cholelithiasis and recent cholecystectomy. Clinical and laboratory features were not conclusive about the cause of this acute pancreatitis. However, imaging data contributed to diagnosis suspicion, and the histopathology study of the transpapillary biopsy confirmed the ampullary adenocarcinoma. Whipple's surgery was the procedure of choice, associated with radical lymphadenectomy, followed by an uneventful outcome. Recrudescence of signs and symptoms of acute pancreatitis, with elevated serum levels of bilirrubins and of hepatic canalicular enzymes, should enhance the suspicion index about periampullary tumors. High levels of CA 19-9 can constitute a useful marker of this condition. Transpapillary biopsy can characterize the diagnosis of ampullary malignancies.
The presence of glandular cells in the vagina of hysterectomized women can have several origins. These cells may undergo malignant changes and thus give rise to primary adenocarcinoma of the vagina. This kind of neoplasia is rare and the most common risk factor for its development is the intrauterine exposure to diethylstilbestrol.We report the case of a 70 year old patient with clinical history of hysterectomy at the age of 36 to control bleeding after miscarriage. A mass in the anterior wall of the vagina was detected by ultrasound examination. Vaginal cytology showed atypical glandular cells with features of adenocarcinoma, not otherwise specified. The subsequent biopsy showed a vaginal adenocarcinoma.There was no clinical information about possible intrauterine exposure to diethylstilbestrol.
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