Ampullary carcinoma is an uncommon gastrointestinal disease. Its natural history is often characterized by the occurrence
of liver metastases. Among patients who undergo pancreatoduodenectomy, those presenting with lymph nodes
involvement are more prone to early distant disease relapse. In this report, a patient previously diagnosed with ampullary
carcinoma had been treated with curative surgery. After subsequent adjuvant gemcitabine, the patient developed significant
myelotoxicity and suffered from a single liver metastasis a few months later. A hepatic intra-arterial mitomycin
plus fluorouracil-based chemotherapy was administered in order to avoid any serious systemic toxicity. The treatment
was well tolerated and no serious side effects occurred. Extra-hepatic cancer relapse, involving intra-thoracic and
abdominal lymph nodes, was observed not long after the initial intra-hepatic almost complete response. In conclusion,
the locoregional chemotherapy administration was effective in overcoming any systemic toxicities and showed activity
against the liver metastasis but it did not prevent extra-hepatic cancer dissemination.