PMC4531577_01
Endoscopic view of carcinoid tumor of the ampulla of Vater. Side-viewing duodenoscope showed a rather prominent, but preserved configuration of the ampulla, and depressed erosion (arrow) with hyperemia on the covering mucosa.
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An examination with a side-viewing duodenoscope showed prominent, but a preserved configuration of the ampulla, but depressed erosion with hyperemia on the covering mucosa (Figure 1).
EUS showed a 0.7x0.3 cm sized, hypoechoic lesion (arrows) confined to the mucosal layer. The proper muscle layer was intact.
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This revealed a hypoechoic, ovoid shaped lesion less than 1 cm in diameter arising from the mucosal layer (Figure 2).
Endoscopic snare papillectomy of a carcinoid tumor of the ampulla of Vater. (A) Endoscopic view showing snaring of the carcinoid tumor of the ampulla of Vater after a submucosal injection of saline solution. (B) Endoscopic view immediately after papillectomy using blended electrosurgical current (C) Biliary (7 Fr, 3 cm) and pancreatic (5 Fr, 3 cm) stents were inserted to prevent possible cholangitis and pancreatitis. (D) Gross finding of the resected specimen.
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The patient then underwent endoscopic snare papillectomy for the removal of the carcinoid tumor of the ampulla of Vater (Figure 3).
Pathological findings of a carcinoid tumor of the ampulla of Vater. (A) Under low power magnification, the typical histological appearance of an intramucosal tumor is seen. The tumor is a discrete, though not encapsulated, mass of multiple nests of small cells in the deep mucosa (hematoxylin and eosin, x10). (B) The nests of a carcinoid tumor have a typical endocrine appearance, with small round cells having small round nuclei and pink to pale blue cytoplasm (hematoxylin and eosin, x40).
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Pathologic analysis of the resected specimen revealed a 0.7x0.5x0.1 cm sized carcinoid tumor of the ampulla of Vater within the mucosal layer (Figure 4).