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<p class="ql-align-justify">Superficial biopsy shows fragments of duodenal mucosa with a tubulovillous proliferation composed of complex villous fronds and crowded tubular glands. The lining epithelium exhibits high-grade dysplasia characterized by pseudostratified hyperchromatic elongated nuclei, loss of polarity, marked nuclear crowding, and increased mitotic activity. The lamina propria shows acute and chronic inflammatory infiltrates with hemorrhage and surface erosion. No definite stromal invasion or desmoplastic stromal response is identified in the examined biopsy fragments.</p>
<p class="ql-align-justify">Obstructive jaundice and biliary dilatation, with duodenoscopy revealing an infiltrative ampullary mass suspicious for malignancy.</p>
<p class="ql-align-justify">Soft tissue fragments collectively measured 0.7 cm, totally embedded.</p>
<p><strong><em><u>Ampulla of Vater, Endoscopic Biopsy:</u></em></strong></p><ul><li><strong>Superficial biopsy, consistent with tubulovillous adenoma, with high-grade dysplasia.</strong></li></ul><p><br></p><p><strong>Comment</strong>:</p><p class="ql-align-justify">No definitive evidence of invasive adenocarcinoma is identified in the examined biopsy fragments. Given the limitations of superficial endoscopic sampling, correlation with the clinical, endoscopic, and radiologic findings is recommended. Complete excision is advised for definitive histopathologic evaluation.</p>
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