Adenocarcinoma of the ampulla of Vater metastasising into the right ventricle

A 43-year-old woman, after resected adenocarcinoma of the ampulla of Vater, presented dyspnoea and beginning signs of right heart failure. Echocardiography revealed a mass within the right ventricle (RV) suspicious for a metastasis of the known adenocarcinoma. The decision for surgical resection was made by cardiovascular MR, which was able to delineate the infiltrative growth of a metastasis. An extensive resection had to be performed. Parts of the intraventricular septum as well as the tricuspid valve had to be resected. After six cycles of adjuvant systemic chemotherapy with gemcitabine and nab-paclitaxel, the patient had no macroscopic tumour recurrence. To our knowledge, this is the first report of a pancreatobiliary tumour metastasising exclusively to the RV of the heart. We conclude that in this special case aggressive surgical management following chemotherapy was very effective in controlling the disseminated adenocarcinoma of the ampulla of Vater.

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