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. 2021 Nov 27;13(11):1338–1350. doi: 10.4240/wjgs.v13.i11.1338

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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

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: http://creativecommons.org/Licenses/by-nc/4.0/

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A 7-cm polypoid tubulovillous adenoma extending from the ampulla of Vater down to D3, removed by means of open surgical ampullectomy-excision of adenoma en block, following cholecystectomy and catheterization of the ampulla for identification. Preoperative biopsies showed low-grade dysplasia (LGD) and this 74-year old patient with severe comorbidities was initially counselled for pancreatoduodenectomy. Meticulous preoperative endoscopic evaluation revealed its polypoid configuration, possibly emanating from a mucosal stalk, which was confirmed intraoperatively. A: The ampulla is encircled by a fine catheter. Final histology confirmed the presence of a tubulovillous adenoma with extensive LGD and focal high-grade dysplasia. All margins were clear of tumour or dysplasia. (V. Mavroeidis’ archive). B: Inferior aspect of the specimen, depicting the duodenal margin along the tumour, and the insertion point of the catheter into the ampulla. (V. Mavroeidis’ archive).