Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature
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Case report
Minute ampullary carcinoid tumor with lymph node metastases: a case report and review of literature Eri Senda*1, Koji Fujimoto2, Katsuhiro Ohnishi1, Akihiro Higashida1, Cho Ashida1, Toshio Okutani1, Shigeru Sakano2, Masayuki Yamamoto2, Rieko Ito3 and Hajime Yamada1 Address: 1Department of Gastroenterology and Hepatology, Shinko Hospital, Kobe, Hyogo 651-0072, Japan, 2Department of Surgery, Shinko Hospital, Kobe, Hyogo 651-0072, Japan and 3Department of Pathology, Shinko Hospital, Kobe, Hyogo 651-0072, Japan Email: Eri Senda* - [email protected]; Koji Fujimoto - [email protected]; Katsuhiro Ohnishi - [email protected]; Akihiro Higashida - [email protected]; Cho Ashida - [email protected]; Toshio Okutani - [email protected]; Shigeru Sakano - [email protected]; Masayuki Yamamoto - [email protected]; Rieko Ito - [email protected]; Hajime Yamada - [email protected] * Corresponding author
Published: 22 January 2009 World Journal of Surgical Oncology 2009, 7:9
doi:10.1186/1477-7819-7-9
Received: 20 November 2008 Accepted: 22 January 2009
This article is available from: http://www.wjso.com/content/7/1/9 © 2009 Senda et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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. Case presentation: 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. Conclusion: 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.
Background Carcinoid tumors are generally considered to be indolent endocrine cell tumor
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