PMC4748198_01
Abdominal/pelvic CT demonstrating the ampullary mass (arrow).
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F1
Abdominal/pelvic CT scan revealed moderately dilated biliary ducts, a slightly dilated pancreatic duct, and a 2.5-cm lobulated and enhancing mass at the level of the ampulla (Figure 1).
Endoscopic image of ampullary mass.
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F2
Esophogogastroduodenoscopy (EGD) revealed a large, 2.5-cm mass at the major papilla spreading across at least 1 duodenal fold, and multiple biopsies were obtained with cold forceps (Figure 2).
EUS-guided FNA of the ampullary mass.
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F3
Endoscopic ultrasound (EUS; linear echoendoscope at 7.5 MHz) demonstrated the 2.5-cm, ill-defined mass (Figure 3), as well as a slightly dilated common bile duct (maximum diameter of 10.2 mm) and dilated pancreatic duct (6.5 mm in the head and 6 mm in the body and tail).
Biopsied tissue during EGD demonstrating neoplastic cells with (A) cytoplasmic staining with anti-somatostatin antibody (x200 magnification), and (B) neoplasm with pseudoglandular architecture composed of cells with abundant granular eosinophilic cytoplasm. Intraluminal calcification with concentric laminations represents a psammoma body (H&E staining, x400 magnification).
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F4
The biopsied tissue obtained during the EGD demonstrated an acinar architecture with associated psammomatous calcifications and positive staining for chromogranin and synaptophysin, consistent with a grade 1 ampullary somatostatinoma (Figure 4).