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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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(a) The resected specimen contains a small yellowish submucosal tumor (approximately 7 mm in diameter) located at the ampulla of Vater (arrow). (b) Monotonous tumor cells with small round nuclei are seen (hematoxylin and eosin staining, × 400). (c) Carcinoid tumor cells within a peripancreatic lymph node (× 200). (d) The tumor cells are positive for synaptophysin, a neuroendocrine marker (× 40). (e) Endolymphatic tumor emboli are shown by staining with D2-40 antibody (× 400). (f) Positive staining for MIB-1 antibody is seen in approximately 3.2% of the tumor cell nuclei (× 400).
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Figure 4: (a) The resected specimen contains a small yellowish submucosal tumor (approximately 7 mm in diameter) located at the ampulla of Vater (arrow). (b) Monotonous tumor cells with small round nuclei are seen (hematoxylin and eosin staining, × 400). (c) Carcinoid tumor cells within a peripancreatic lymph node (× 200). (d) The tumor cells are positive for synaptophysin, a neuroendocrine marker (× 40). (e) Endolymphatic tumor emboli are shown by staining with D2-40 antibody (× 400). (f) Positive staining for MIB-1 antibody is seen in approximately 3.2% of the tumor cell nuclei (× 400).

Mentions: The resected tumor was a small yellowish submucosal mass (7 mm in diameter) located at the ampulla of Vater (Figure 4-a). Tumor cells were detected under the ampullary epithelium, spreading over the sphincter of Oddi to reach the muscularis propria, and infiltrating into the CBD wall to create submucosal thickening (Figure 4-b). The tumor cells were also found in 2 peripancreatic lymph nodes (Figure 4-c). The tumor cells were strongly stained by synaptophysin antibody (Figure 4-d. Immunohistochemical staining using D2-40 antibody showed lymphatic involvement (Figure 4-e), and the Ki-67 labeling index of the tumor cells determined with MIB-1 was 3.2% (Figure 4-f) and overexpression of p53 was not detected. According to the classification of neuroendocrine tumors by The World Health Organization [4], our patient's tumor with regional lymph node metastases and an MIB-1 proliferative index of more than 2% was a well-differentiated endocrine carcinoma (malignant carcinoid). The patient remains free of disease and is leading a normal life at 24 months after the operation.


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)

(a) The resected specimen contains a small yellowish submucosal tumor (approximately 7 mm in diameter) located at the ampulla of Vater (arrow). (b) Monotonous tumor cells with small round nuclei are seen (hematoxylin and eosin staining, × 400). (c) Carcinoid tumor cells within a peripancreatic lymph node (× 200). (d) The tumor cells are positive for synaptophysin, a neuroendocrine marker (× 40). (e) Endolymphatic tumor emboli are shown by staining with D2-40 antibody (× 400). (f) Positive staining for MIB-1 antibody is seen in approximately 3.2% of the tumor cell nuclei (× 400).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: (a) The resected specimen contains a small yellowish submucosal tumor (approximately 7 mm in diameter) located at the ampulla of Vater (arrow). (b) Monotonous tumor cells with small round nuclei are seen (hematoxylin and eosin staining, × 400). (c) Carcinoid tumor cells within a peripancreatic lymph node (× 200). (d) The tumor cells are positive for synaptophysin, a neuroendocrine marker (× 40). (e) Endolymphatic tumor emboli are shown by staining with D2-40 antibody (× 400). (f) Positive staining for MIB-1 antibody is seen in approximately 3.2% of the tumor cell nuclei (× 400).
Mentions: The resected tumor was a small yellowish submucosal mass (7 mm in diameter) located at the ampulla of Vater (Figure 4-a). Tumor cells were detected under the ampullary epithelium, spreading over the sphincter of Oddi to reach the muscularis propria, and infiltrating into the CBD wall to create submucosal thickening (Figure 4-b). The tumor cells were also found in 2 peripancreatic lymph nodes (Figure 4-c). The tumor cells were strongly stained by synaptophysin antibody (Figure 4-d. Immunohistochemical staining using D2-40 antibody showed lymphatic involvement (Figure 4-e), and the Ki-67 labeling index of the tumor cells determined with MIB-1 was 3.2% (Figure 4-f) and overexpression of p53 was not detected. According to the classification of neuroendocrine tumors by The World Health Organization [4], our patient's tumor with regional lymph node metastases and an MIB-1 proliferative index of more than 2% was a well-differentiated endocrine carcinoma (malignant carcinoid). The patient remains free of disease and is leading a normal life at 24 months after the operation.

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