Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature.
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.
Senda
Eri
E
Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo, Japan. erisenda@shinkohp.or.jp
Fujimoto
Koji
K
Ohnishi
Katsuhiro
K
Higashida
Akihiro
A
Ashida
Cho
C
Okutani
Toshio
T
Sakano
Shigeru
S
Yamamoto
Masayuki
M
Ito
Rieko
R
Yamada
Hajime
H
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