Neuroendocrine tumor of the ampulla of Vater with distant cystic lymph node metastasis: a case report

Abstract

BackgroundNeuroendocrine tumors (NETs) of the ampulla of Vater are rare and difficult to diagnose. We report a rare case of a small NET of the ampulla of Vater with metastasis to distant lymph nodes.Case presentationThe patient was a 54-year-old man complaining of epigastric pain and melena. Upper gastrointestinal endoscopy revealed a bulging papilla with active bleeding, which was diagnosed as a well-differentiated NET of the ampulla of Vater. An approximately 10-mm hypervascular tumor at the ampulla of Vater and a 41-mm cyst adjacent to the wall of the jejunum were revealed by abdominal computed tomography. We performed pylorus-preserving pancreaticoduodenectomy with lymph node dissection. Macroscopic examination revealed a 9-mm tumor of the ampulla of Vater and a 52-mm cyst adjacent to the wall of the jejunum. Histological examination revealed that the cyst was a lymph node metastasis. The final diagnosis was non-functional NET G1 of the ampulla of Vater, designated T1N1M0 stage IIIB. Postoperatively, the patient underwent no treatment and has had no recurrence for 4 years.ConclusionsThis case demonstrates that sporadic NETs of Vater’s papilla have aggressive metastatic potential even with a small primary lesion, and radical resection with lymphadenectomy is recommended for all cases.

MRI Findings of an Ampulla of Vater Neuroendocrine Tumor with Liver and Lymph Node Metastasis: a Case Report

“…NETs show low signal intensity on a T1-weighted image and high signal intensity on a T2-weighted image (1,7). Further, the reported CT findings of AOV-NETs are hypervascular masses at the AOV with or without dilatation of the common bile and main pancreatic duct (6,8). The AOV-NET was well visualized on the MRI as a small, homogeneous hypervascular masses in the AOV, which is a typical imaging feature of a NET in the present case.…”

Cystic metastasis of prostate cancer

“…Solid components and different degrees of enhancement were observed in lymph node metastasis. [9] During histological examination, no residual lymph node tissue was found in the lesion and the wall of the cyst. There was no reliable evidence for lymph node metastasis as well.…”