Ampullary masses constitute a rare but important pathology of the biliopancreatic junction. They include benign or malignant lesions that may manifest as cholestatic jaundice, sometimes associated with pancreatic pain. This work aimed to describe the epidemiological, clinical, radiological, and histological characteristics of ampullary masses.

Patients and Methods

This was a retrospective descriptive study including all patient hospitalized for suspicion or confirmation of an ampullary mass in the Medicine C Department of CHU Avicenne between 2020 and 2025. Data were collected from medical records, imaging examinations (ultrasound, CT scan, MRCP, endoscopic ultrasound), and histological results.

We recorded 40 cases of ampullary masses. The mean age of the patients was 64 years, with extremes ranging from 38 to 91 years. A female predominance was noted (55%, n = 22) with a male-to-female sex ratio of 0.81. The main clinical presentation was cholestatic jaundice observed in 87.5% of cases (n = 35), followed by pancreatic pain in 12.5% of cases (n = 5). Imaging showed double-duct sign in 82.5% of cases (n = 33), with a tissue process at the biliopancreatic junction measuring on average 17 mm (10–30 mm), responsible for an average dilation of the common bile duct to 15 mm (6–30 mm) and of the Wirsung duct to 6 mm (3–11 mm).

Histologically, 65% of the lesions corresponded to ampullary adenocarcinoma (n = 26), 10% to high-grade dysplasia (n = 4), 5% to a neuroendocrine tumor (n = 2), 5% to benign lesions (n = 2), and 15% of biopsies (n = 6) were negative or non-contributive.

EUSstaging showed a predominance of stage T2 (45%, n = 18) followed by T3 (30%, n = 12), T1 (20%, n = 8), and T4 (5%, n = 2). Lymph node involvement was observed in 30% of cases (n = 12) and metastases in 5% (n = 2).

Regarding treatment, endoscopic ampullectomy was performed in 20% of patients (n = 8) and cephalic duodenopancreatectomy in 25% (n = 10). The remaining 55% (n = 22), who did not undergo any curative procedure, were managed palliatively, mainly with biliary drainage and stent placement.

The evolution was favorable in 60% of cases (n = 24), with 20% deaths (n = 8) and 20% lost to follow-up (n = 8).

ampullary masses represent a significant cause of cholestatic jaundice in elderly patients, with a female predominance and a clear predominance of malignant forms dominated by adenocarcinoma. Modern imaging techniques, particularly endoscopic ultrasound and MRCP, help refine the diagnosis and guide management. Treatment is based on surgery or endoscopic ampullectomy depending on the stage and histological nature. Despite diagnostic advances, the prognosis remains poor in infiltrative forms, highlighting the importance of early diagnosis and close follow-up.