A Case of a Carcinoid Tumor of the Ampulla of Vater With a Lipoma of the Stomach

Abstract

We report a rare case of a carcinoid tumor of the ampulla of Vater and discuss the treatment. A 73-year-old woman, pointed out abnomalities on upper gastrointestinal investigation (UGI), was seen at the hospital. The UGI showed a smooth defect in the antral region, and a swelling with a partial depressive lesion in the ampulla of Vater accidentally. There was a 1.8 x 1.3cm low echoic area in the submucosal layer on an endoscopic echogram. Biopsy specimen revealed a carcinoid tumor histopath ologically. A pylorus-reserved pancreaticoduodenectomy with dissection of the regional lymph nodes was performed. During the operation, we found two thumb-sized lymph nodes in the first branch of the jejunal artery. On the frozen section, the metastasis of the carcinoid tumor was diagnosed. The invation of the tumor to the duodenal mucosa and lymph vessels was observed microscopically, and tumor cells showed positive immunohistochemical staining for somatostatin. Surgical stage was III. She has been alive without recurrence for 1 year after the operation. Concerning the therapy of the carcinoid tumor, it is important to evaluate the lymph node metastasis as well as the tumor size preoperatively, and the radical resection combined lymph nodes dessection is necessary.