Rare cause of jaundice- Ampullary tumors

Ampullary tumors are a rare but important cause of obstructive jaundice, arising from the ampulla of Vater at the junction of the common bile and pancreatic ducts. These lesions, while often benign, may harbor premalignant or malignant potential and are commonly associated with hereditary polyposis syndromes such as familial adenomatous polyposis. We present the case of an 84-year-old female with a history of breast cancer and seizures who was incidentally found to have elevated liver enzymes and lipase on outpatient testing. MRCP revealed biliary dilation with a distal common bile duct filling defect. ERCP demonstrated choledocholithiasis and a prominent ampulla. After sphincterotomy, abnormal tissue was noted and biopsied, revealing a tubular adenoma without dysplasia. Further evaluation with EUS showed no pancreatic involvement. The patient underwent endoscopic resection and recovered uneventfully. This case highlights the importance of considering ampullary neoplasms in elderly patients with unexplained biliary obstruction, even in the absence of a polyposis syndrome. Endoscopic biopsy and resection are critical for diagnosis and management, while surveillance is essential for recurrence or malignant transformation. Early recognition and appropriate referral for endoscopic or surgical intervention can improve outcomes in these patients.