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An association between ampullary adenoma and adenocarcinoma has been reported previously.1 However, we believe that this is the first report of the synchronous occurrence of adenocarcinoma of the ampulla of Vater and a gastrointestinal stromal tumour (GIST).
A 41 year old woman was admitted to our hospital for the evaluation of jaundice. Her liver function tests were as follows: alanine aminotransferase, 37 U/litre (normal range, 0–31); aspartate aminotransferase, 32 U/litre (normal range, 0–32); alkaline phosphatase, 598 U/litre (normal range, 0–240); total bilirubin, 203.2 mg/litre (normal range, 1–11); direct biluribin, 151.6 mg/litre (normal range, 0–3).
Ultrasonography, computed tomography, and magnetic resonance imaging studies showed intrahepatic and extrahepatic bile duct dilatation. Termination of the common bile duct at the distal end by a mass was noted (fig 1). The initial radiological differential diagnosis included pancreatic …