Retroperitoneal germ cell tumor mimicking neoplasm of ampulla of Vater
DOI:
https://doi.org/10.18203/2349-2902.isj20182254Keywords:
Extragonadal germ cell tumor, Extrinsic bile duct strictures, Retroperitoneal germ cell tumor, Neoplasms of ampulla of VaterAbstract
A 20-year-old man previously healthy, presented to the emergency department for evaluation of obstructive jaundice, backache and weight loss. Abdominal ultrasonography demonstrated a dilated common bile duct (up to 2 cm), increased gallbladder dimensions (10.3 x 4.9 cm) with biliary sludge. Computed tomography of the abdomen showed a retroperitoneal tumor with 18 x 14 cm dimensions, and numerous large retroperitoneal lymph nodes. The liver demonstrated a bilateral intrahepatic bile duct dilatation. An endoscopic retrograde cholangiography was performed. The study revealed an ulcerative neoplasm of ampulla of Vater, and the cholangiogram obtained images of dilated extra-hepatic and intra-hepatic bile ducts with a large stenosis in the distal third of the common bile duct. After biopsies were analyzed, the definite diagnosis was a retroperitoneal extragonadal germ cell tumor (subtype: embryonal carcinoma) with infiltrative invasion to duodenal wall. A testicular ultrasonography ruled out a testicular tumor. Endoscopic stenting was necessary for decompress the unresectable malignant bile duct obstruction. Patient was referred for cisplatinum based chemotherapy.
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