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Biopsies were taken from both the ampullary mass and the gastric polyps.

Pathology revealed the gastric polyps to be fundic gland polyps and the ampullary mass biopsy showed adenomatous mucosa with focal high grade dysplasia.

Purpose: To report a rare case and emphasize the significant association of AFAP with ampullary adenocarcinoma.

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Initial laboratory values revealed a total bilirubin of 21.6 mg/d L with direct bilirubin 12.6 mg/d L, alkaline phosphatase 462 IU/L, aspartate transaminase 73 IU/L, alanine transaminase 85 IU/L, amylase 64 IU/L, lipase 32 IU/L, and white blood cell count of 8.8 thousand per cubic millimeter.

Colonoscopy was then performed which revealed numerous 1–5 mm polyps in the ascending colon, hepatic flexure, and proximal transverse colon.

Nisheeth Verma, MD*, Avinash Murthy, MD, Vinay Sood, DO, Konstantinos Linos, MD.

Pathology, Gastroenterology, Internal Medicine, Albany Medical College, Albany, NY.

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Follow up CT scan of the abdomen and pelvis revealed a 2.7 2.2 cm mass in the region of the ampulla/ pancreatic head.

Further work up with endoscopic ultrasound identified the mass at the level of the ampulla, which was staged T2N0Mx by endosonographic criteria.

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