case_images: PMC11770243_01
case_images: Axial image demonstrating an ivory vertebra at L2 (arrow), with increased opacity of the vertebral body.
case_images: cureus-0017-00000077978-i01.jpg
case_images: PMC11770243_01_cureus-0017-00000077978-i01.jpg
case_images: FIG1
case_images: Axial image showing pulmonary nodules in the left lower lobe, with the largest measuring 6.5 mm in size (arrow).
case_images: cureus-0017-00000077978-i02.jpg
case_images: PMC11770243_01_cureus-0017-00000077978-i02.jpg
case_images: FIG2
case_images: During hospitalization, a chest CT scan revealed peripheral nonspecific infracentimetric pulmonary micronodules without associated adenopathy (Figure 2).
case_images: Sagittal image of the vertebral column, with the arrow highlighting the ivory vertebra sign at L2.
case_images: cureus-0017-00000077978-i03.jpg
case_images: PMC11770243_01_cureus-0017-00000077978-i03.jpg
case_images: FIG3
case_images: Image of the ulcerated tumor in the papilla of Vater (arrow) obtained through endoscopic retrograde cholangiopancreatography (ERCP).. Image obtained through ERCP showing an ulcerated, exophytic, ulcerofungating tumour in the duodenal lumen. The tumour eccentrically engulfs the ampulla of Vater orifice, with minimal involvement of the intra-ampullary region (arrow).
case_images: cureus-0017-00000077978-i04.jpg
case_images: PMC11770243_01_cureus-0017-00000077978-i04.jpg
case_images: FIG4
case_images: The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) that revealed dilation of the common bile duct and the pancreatic duct (double duct sign) with papillary stenosis caused by an ulcerated and exophytic tumour growing in the ampulla of Vater (Figure 4).
case_images: Histology of the ulcerated tumor in the papilla of Vater. Fragments of mucosa from the anatomical region showing infiltration by a gland-forming (tubular) adenocarcinoma consisting of relatively small glands separated by a desmoplastic stroma (A). The glands are predominantly small and lined by a single layer of pleomorphic cuboidal to low columnar cells, exhibiting a pancreatobiliary pattern (inset B); in some other areas, the glands are lined by tall columnar cells with elongated, pseudostratified nuclei, reflecting an intestinal pattern (inset C). These findings are consistent with a tubular adenocarcinoma with mixed features, with a predominant pancreatobiliary pattern.
case_images: cureus-0017-00000077978-i05.jpg
case_images: PMC11770243_01_cureus-0017-00000077978-i05.jpg
case_images: FIG5
case_images: The biopsy showed infiltration by a moderately differentiated tubular adenocarcinoma with mixed features, with a predominant pancreatobiliary pattern (Figure 5).