Abstract
BackgroundCarcinoid 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 presentationWe 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.ConclusionRecently 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.
Highlights
Carcinoid tumors are usually considered to have a low degree of malignancy and show slow progression
Whipple resection is the usual surgical treatment for this disease, but less radical procedures such as local excision or endoscopic ampullectomy have recently been reported for small carcinoid tumor [1,2,3], which are generally considered to be benign
World Journal of Surgical Oncology 2009, 7:9 http://www.wjso.com/content/7/1/9 ullary carcinoid (7 mm in diameter) that showed regional lymph node metastases, and we review the literature with emphasis on the treatment of this disease
Summary
Small ampullary carcinoids (less than 10 mm in diameter) are generally considered to be benign and there have been some reports of local excision or endoscopic ampullectomy for those tumors. We encountered the patient who had a minute ampullary carcinoid (7 mm in diameter) associated with regional lymph node metastases. This case provides evidence that carcinoid of the ampulla of Vater, irrespective of its size, might have the potential to metastasize to the regional lymph nodes, that the patients should be examined in detail concerning the existence of metastases as well as that of regional infiltration of the tumor. Written informed consent was obtained from the patient for publication of this case report and the accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal
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