Small Carcinoid Tumor of Papilla of the Vater with Lymph Node Metastases

Abstract

A 59-year-old woman, who was diagnosed with liver dysfunction and underwent a cholecystectomy, was referred to our institution with a suspected ampullary tumor. Computed tomography showed 1 cm of enhancement at the duodenal ampulla, but no visible lymph adenopathy. In the duodenoscopic view, her papilla was slightly enlarged without orifice, so that forceps biopsy was performed from the common ampullary channel after needle-knife incision. Tissue obtained by biopsy revealed a possible carcinoid tumor, with 1.1% of Ki-67 labeling index. Pancreatoduodenectomy was performed, and the resected specimen showed a carcinoid tumor of the ampulla, 1.2 cm in diameter, with metastases to regional lymph nodes and a 4% Ki-67 labeling index. It is suggested that despite the small size and low proliferation index, an ampullary carcinoid may not be cured by local resection. Clinicians must pay careful attention to the choice of treatment and monitoring after the resection.

Ampullary Neuroendocrine Neoplasm: Clinicopathological Characteristics and Novel Endoscopic Entity

“…In certain situations, such as a tumor size <10 mm, NET G1, and nonfunctioning tumors, EP could be a viable treatment option. Furthermore, pathological diagnosis after EP is important to consider additional surgical resection because small ampullary tumors of NET G2 with lymph node metastases have been reported [29, 30].…”

Three Cases of Ampullary Neuroendocrine Tumor Treated by Endoscopic Papillectomy: A Case Report and Literature Review

“…However, small ampullary NETs (7 to 10 mm in diameter) with lymph-node metastasis have also been reported. Therefore, long-term follow-up is mandatory after EP of ampullary NETs (19,20).…”

Endoscopic Resection of Ampullary Neuroendocrine Tumor

“…Two cases of successful endoscopic resection for ampullary NETs 1.5 cm in diameter (6,7) have also been reported. However, given that small ampullary NETs (1.2 cm in diameter and 0.7 cm in diameter) with lymph node metastasis have also been reported (10,11), long-term follow-up is necessary after endoscopic resection of ampullary NETs.…”