title: Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan. erisenda@shinkohp.or.jp
authors.forename: Eri
authors.initials: E
authors.lastname: Senda
authors.forename: Koji
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Higashida
authors.forename: Cho
authors.initials: C
authors.lastname: Ashida
authors.forename: Toshio
authors.initials: T
authors.lastname: Okutani
authors.forename: Shigeru
authors.initials: S
authors.lastname: Sakano
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Rieko
authors.initials: R
authors.lastname: Ito
authors.forename: Hajime
authors.initials: H
authors.lastname: Yamada
mesh_terms: D014670:Ampulla of Vater; D001706:Biopsy; D002276:Carcinoid Tumor / Q000556:secondary* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D014057:Tomography, X-Ray Computed