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Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature.

Senda E, Fujimoto K, Ohnishi K, Higashida A, Ashida C, Okutani T, Sakano S, Yamamoto M, Ito R, Yamada H - World J Surg Oncol (2009)

Bottom Line: We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases.Mild elevation of liver enzymes was found at her regular medical check-up.Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan. erisenda@shinkohp.or.jp

ABSTRACT

Background: Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection.

Case presentation: We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT) revealed a markedly dilated common bile duct (CBD) and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter) at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor.

Conclusion: Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.

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Related in: MedlinePlus

Endoscopy shows a slightly enlarged ampullary region, suggesting the existence of a submucosal tumor because the epithelium has a normal appearance.
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Figure 2: Endoscopy shows a slightly enlarged ampullary region, suggesting the existence of a submucosal tumor because the epithelium has a normal appearance.

Mentions: The patient was a 63-year-old woman who had been attending our hospital for hypercholestelemia once a month. At her regular medical check-up, mild elevation of liver enzymes was detected, and then she was admitted to our hospital for further assessment. Contrast-enhanced computed tomography (CT) revealed marked dilatation of the common bile duct (CBD) and 2 enlarged lymph nodes in the peripancreatic region (Figure 1-a, b). Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor, although its epithelium had a normal appearance (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) also demonstrated a markedly dilated CBD with moderate stenosis in its distal portion (Figure 3). The biopsy specimen obtained from inside the papilla after endoscopic sphinctectomy contained tumor cells with small round nuclei showing monotonous proliferation. Immunohistochemical examination demonstrated that the tumor cells were positive for neuroendocrine markers, such as chromogranin, synaptophysin, and neural cell adhesion molecule (NCAM), suggesting that the lesion was a carcinoid. Although serum serotonin and urinary 5-HIAA levels were within the normal range, a diagnosis of ampullary carcinoid tumor with local lymph node metastases was preoperatively made. She subsequently underwent the whipple resection with extended lymph node dissection. We did not perform frozen slide examination of the lymph nodes in the peripancreatic region before the resection, since the images of those enlarged lymph nodes (e.g. round shape and well-enhanced) shown by contrast-enhanced CT were typical for metastasis from carcinoid tumor as shown in Figure 1-a, b.


Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature.

Senda E, Fujimoto K, Ohnishi K, Higashida A, Ashida C, Okutani T, Sakano S, Yamamoto M, Ito R, Yamada H - World J Surg Oncol (2009)

Endoscopy shows a slightly enlarged ampullary region, suggesting the existence of a submucosal tumor because the epithelium has a normal appearance.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2636813&req=5

Figure 2: Endoscopy shows a slightly enlarged ampullary region, suggesting the existence of a submucosal tumor because the epithelium has a normal appearance.
Mentions: The patient was a 63-year-old woman who had been attending our hospital for hypercholestelemia once a month. At her regular medical check-up, mild elevation of liver enzymes was detected, and then she was admitted to our hospital for further assessment. Contrast-enhanced computed tomography (CT) revealed marked dilatation of the common bile duct (CBD) and 2 enlarged lymph nodes in the peripancreatic region (Figure 1-a, b). Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor, although its epithelium had a normal appearance (Figure 2). Endoscopic retrograde cholangiopancreatography (ERCP) also demonstrated a markedly dilated CBD with moderate stenosis in its distal portion (Figure 3). The biopsy specimen obtained from inside the papilla after endoscopic sphinctectomy contained tumor cells with small round nuclei showing monotonous proliferation. Immunohistochemical examination demonstrated that the tumor cells were positive for neuroendocrine markers, such as chromogranin, synaptophysin, and neural cell adhesion molecule (NCAM), suggesting that the lesion was a carcinoid. Although serum serotonin and urinary 5-HIAA levels were within the normal range, a diagnosis of ampullary carcinoid tumor with local lymph node metastases was preoperatively made. She subsequently underwent the whipple resection with extended lymph node dissection. We did not perform frozen slide examination of the lymph nodes in the peripancreatic region before the resection, since the images of those enlarged lymph nodes (e.g. round shape and well-enhanced) shown by contrast-enhanced CT were typical for metastasis from carcinoid tumor as shown in Figure 1-a, b.

Bottom Line: We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases.Mild elevation of liver enzymes was found at her regular medical check-up.Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan. erisenda@shinkohp.or.jp

ABSTRACT

Background: Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression. One of the factors indicating the malignancy of these tumors is their size, and small ampullary carcinoid tumors have been sometimes treated by endoscopic resection.

Case presentation: We report a case of a 63-year-old woman with a minute ampullary carcinoid tumor that was 7 mm in diameter, but was associated with 2 peripancreatic lymph node metastases. Mild elevation of liver enzymes was found at her regular medical check-up. Computed tomography (CT) revealed a markedly dilated common bile duct (CBD) and two enlarged peripancreatic lymph nodes. Endoscopy showed that the ampulla was slightly enlarged by a submucosal tumor. The biopsy specimen revealed tumor cells that showed monotonous proliferation suggestive of a carcinoid tumor. She underwent a pylorus-preserving whipple resection with lymph node dissection. The resected lesion was a small submucosal tumor (7 mm in diameter) at the ampulla, with metastasis to 2 peripancreatic lymph nodes, and it was diagnosed as a malignant carcinoid tumor.

Conclusion: Recently there have been some reports of endoscopic ampullectomy for small carcinoid tumors. However, this case suggests that attention should be paid to the possibility of lymph node metastases as well as that of regional infiltration of the tumor even for minute ampullary carcinoid tumors to provide the best chance for cure.

Show MeSH
Related in: MedlinePlus