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Case Reports in Pathology
Volume 2014, Article ID 530727, 6 pages
Case Report

A Rare Collision Tumor Composed of Follicular Lymphoma and Adenocarcinoma in the Ampulla of Vater: A Case Report

1Division of Pathology, Iwata City Hospital, 512-3 Ookubo, Iwata, Shizuoka 438-8550, Japan
2Division of Gastroenterological Surgery, Iwata City Hospital, 512-3 Ookubo, Iwata, Shizuoka 438-8550, Japan
3Division of Gastroenterology, Iwata City Hospital, 512-3 Ookubo, Iwata, Shizuoka 438-8550, Japan

Received 11 March 2014; Accepted 12 April 2014; Published 28 April 2014

Academic Editor: Katsuyuki Aozasa

Copyright © 2014 Shioto Suzuki et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The duodenum is infrequently affected by malignant lymphoma, and follicular lymphomas of the duodenum are rare histological subtypes. There are no reported cases of collision of follicular lymphoma and other tumors in the ampulla of Vater. A 57-year-old Japanese man presented with jaundice, and abdominal computed tomography revealed a tumor of the ampulla of Vater invading the pancreatic head with biliary dilatation and a thickened duodenal wall. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Histopathology of the resected specimen revealed lymphoid follicular formations with small-to-medium-sized centrocyte-like cells and some centroblast-like cells. The atypical lymphoid cells were immunohistochemically positive for CD10, CD20, and CD79a but negative for CD5 and cyclin D1. BCL2 protein was highly expressed in the follicle centers. The diagnosis was duodenal follicular lymphoma, Grade 1. The follicular lymphoma, 40 mm in diameter, involved duodenal submucosa and regional lymph nodes without distant metastasis. This duodenal follicular lymphoma was partially overlapped by adenocarcinoma of the ampulla of Vater, measuring  mm, which involved the lower common bile duct, pancreas, and duodenum. We report the first case of a surgically treated collision tumor composed of a rare mass-forming follicular lymphoma and adenocarcinoma of the ampulla of Vater.