title: Small carcinoid tumor of papilla of the Vater with lymph node metastases.
abstract: BACKGROUND
  Carcinoid of papilla of the Vater is a rare entity. Detailed prognostic factors of this tumor have not yet been elucidated, and treatment choices include local resection and pancreatoduodenectomy with excision of lymph nodes.
  
  
  METHODS
  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.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, 1007, Nagaizumi, Suntogun, Shizuoka, 411-8777, Japan. h.matsubayashi@scchr.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsunaga
authors.forename: Keiko
authors.initials: K
authors.lastname: Sasaki
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Hasuike
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D014670:Ampulla of Vater; D001706:Biopsy; D002276:Carcinoid Tumor / Q000473:pathology*; D003138:Common Bile Duct Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis; D008207:Lymphatic Metastasis; D008875:Middle Aged
chemical_list: D019394:Ki-67 Antigen