The patient was a 41-year-old Chinese female who presented with apparent
jaundice and
itching. An enlarged right supraclavicular lymph node was found during physical examination. Laboratory tests revealed significantly elevated
bilirubin and
aminotransferase. Imaging examinations, including ultrasonography, computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP) revealed a 3.1×2.5×2 cm mass in the distal common bile duct and the ampulla of Vater. The routine chest
x-ray film revealed a 4-cm nodule in the upper lobe of the left lung and further CT scan confirmed the diagnosis of left
lung cancer. A biopsy of supraclavicular lymph node was performed and the histopathology showed poorly differentiated
adenocarcinoma with
cytokeratin-7 (CK-7) and thyroid transcription factor-1 (TTF-1) being positive immunohistochemically. The patient underwent a pylorus preserving
pancreaticoduodenectomy and the histology of the resected specimen revealed characteristic of pulmonary
adenocarcinoma. Thus, the final diagnosis was periampullary
metastasis from pulmonary
adenocarcinoma. The patient's postoperative recovery was uneventful and the
jaundice was disappeared one month later. A pulmonary lobectomy was followed by
chemotherapy with combination of
vinorelbine and
cisplatin for six cycles.
CONCLUSION: