Ampullary adenoma at the initial diagnosis. (A) Duodenoscopy: discolored, partly reddish, lobular protruding tumor. (B) NBI: oval and pinecone/leaf-shaped villi (arrow). (C) Biopsy: tubular adenoma. (D) EUS: hypoechoic mass (arrow) limited to the ampulla without invasion of the duodenal muscularis propria (arrowhead).
Progression to adenocarcinoma after 7 years. (A) Duodenoscopy: easy-bleeding, reddish, uneven surface around the bile-duct orifice. (B) NBI: irregular, non-structured surface (arrow). (C) Biopsy: well-differentiated adenocarcinoma. (D) EUS: hypoechoic mass (arrow) invading the duodenal muscularis propria (arrowhead).
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