Unusual Manifestation of an Ampullary Tumor Presenting with Severe Upper Gastrointestinal Bleeding

Abstract

Ampullary tumors can occasionally ulcerate and present as frank gastrointestinal bleeding. The most common clinical presentation is jaundice like in other tumors of the biliary tree. We report on a 68-year-old man who presented with severe upper gastrointestinal hemorrhage secondary to an asymptomatic mass of the ampulla of Vater. An endoscopic biopsy specimen revealed a villous adenoma with moderate dysplasia. A curative resection was performed, and pathological work-up revealed the presence of an infiltrating, moderately differentiated ampullary adenocarcinoma.

Postmyocardial Infarction Mortality in Relation to Depression: A Systematic Critical Review

“…A similar prevalence rate of 30% for moderate symptoms of depression is found in patients with cancer [6]. In patients with cardiovascular diseases in the form of coronary artery disease [7,8,9] or stroke [10, 11,] approximately 30% have a current depression. This applies also to patients with a recent myocardial infarction (MI) [12, 13].…”

“…However, they were retained, because they reported on different lengths of the follow-up periods and used different depression scales. In the two studies done by Denollet et al [9]; Appendix 1] and Denollet and Brutsaert [11]; Appendix 1], there seems to be an overlap of participants. However, the extent of this cannot be elucidated from the articles, and the first study contained the largest study sample.…”

“…Articles that fitted these criteria were given an identification number [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31] Appendix 1]. They were then systematically reviewed for descriptive information for quality issues.…”

“…Previously published criteria considered being minimum requirements for data collection and interpretation in epidemiological studies were modified and used for the quality assessment [16]. These criteria relate to representativeness of the study sample, quality of data, definition of depression, and sample size to show differences between groups in relation to mortality (Appendix 2).…”

Endoscopic management of adenomatous ampullary lesions

“…Presenting symptoms are usually non-specific, reflecting biliary or pancreatic obstruction. The most common presentation is with painless jaundice, which is present in 50%-75% of patients [21,[31][32][33][34] . Cholangitis or acute pancreatitis are rare manifestations [35][36][37][38] .…”