CRCM  Vol.3 No.3 , March 2014
Ampullary Neuroendocrine Tumor: A Rare Cause of Recurrent Abdominal Pain
ABSTRACT

Ampullary Neuroendocrine tumor (ANET) is a rare GI malignancy, representing less than 1% of GI neuroendocrine tumors and less than 2% of ampullary tumors. Traditional treatment is often a pancreaticoduodenectomy; however, local and endoscopic resections have been successful. We report a rare case of ANET in a 21-year-old Burmese man who presented with a 6-year history of non-specific intermittent abdominal pain who was successfully managed through transduodenal ampullectomy. At 24 months postoperatively he remains disease and symptom free. ANET is a rare cause of recurrent abdominal pain, and local excision of small ANETs can be an alternative, less morbid treatment for young patients. We follow the case with a brief review of the literature.


Cite this paper
Ofosu, A. , Taccone, M. , Potakamuri, L. and Jagannath, S. (2014) Ampullary Neuroendocrine Tumor: A Rare Cause of Recurrent Abdominal Pain. Case Reports in Clinical Medicine, 3, 139-144. doi: 10.4236/crcm.2014.33034.
References
[1]   Ricci, J.L. (1993) Carcinoid of the Ampulla of Vater: Local Resection or Pancreaticoduodenectomy. Cancer, 71, 686-690. http://dx.doi.org/10.1002/1097-0142(19930201)71:3<686::AID-CNCR2820710306>3.0.CO;2-Z

[2]   Ramage, J.K., Davies, A.H.G., Ardill, J., Bax, N., Caplin, M., Grossman, A., et al. (2005) Guidelines for the Management of Gastroenteropancreatic Neuroendocrine (Including Carcinoid) Tumours. Gut, 54, iv1-iv16.
http://dx.doi.org/10.1136/gut.2004.053314

[3]   Albores-Saavedra, J., Hart, A., Chablé-Montero, F. and Henson, D.E. (2010) Carcinoids and High-Grade Neuroendocrine Carcinomas of the Ampulla of Vater: A Comparative Analysis of 139 Cases from the Surveillance, Epidemiology, and End-Results Program—A Population Based Study. Archives of Pathology & Laboratory Medicine, 134, 1692-1696. http://dx.doi.org/10.1043/2009-0697-OAR.1

[4]   Gilani, N. and Ramirez, F.C. (2007) Endoscopic Resection of an Ampullary Carcinoid Presenting with Upper Gastrointestinal Bleeding: A Case Report and Review of the Literature. World Journal of Gastroenterology, 13, 1268-1270.

[5]   Senda, E., Fujimoto, K., Ohnishi, K., Higashida, A., Ashida, C., Okutani, T., et al. (2009) Minute Ampullary Carcinoid Tumor with Lymph Node Metastases: A Case Report and Review of Literature. World Journal of Surgical Oncology, 7, 9. http://dx.doi.org/10.1186/1477-7819-7-9

[6]   Jaoude, W.A., Lau, C., Sugiyama, G. and Duncan, A. (2010) Management of Ampullary Carcinoid Tumors with Pancreaticoduodenectomy. Journal of Surgical Case Reports, 8, 4. http://dx.doi.org/10.1093/jscr/2010.8.4

[7]   Klimstra, D., Modlin, I.R., Coppola, D., Lloyd, R.V. and Suster, S. (2010) The Pathologic Classification of Neuroendocrine Tumors: A Review of Nomenclature, Grading and Staging Systems. Pancreas, 39, 707-712.
http://dx.doi.org/10.1097/MPA.0b013e3181ec124e

[8]   Bosman, F., Carneiro, F., Hruban, R. and Theise, N. (2010) WHO Classification of Tumors of the Digestive System. IARC Press, Lyon.

[9]   Carter, J.T., Grenert, J.P., Rubenstein, L., Stewart, L. and Way, L.W. (2009) Neuroendocine Tumors of the Ampulla of Vater: Biological Behavior and Surgical Management. Archives of Surgery, 144, 527-531.
http://dx.doi.org/10.1001/archsurg.2009.80

[10]   Singhal, D., Vasdev, N., Soin, A., Gupta, S. and Nundy, S. (2006) Distinguishing between Periampullary Carcinoid and Carcinomas—Is This Possible Preoperatively? Indian Journal of Gastroenterology, 25, 206-207.

[11]   Hatzitheoklitos, E., Buchler, M.W., Friess, H., Poch, B., Ebert, M., Mohr, W., et al. (1994) Carcinoid of the Ampulla of Vater. Clinical Characteristics and Morphologic Features. Cancer, 73, 1580-1588.
http://dx.doi.org/10.1002/1097-0142(19940315)73:6<1580::AID-CNCR2820730608>3.0.CO;2-0

[12]   Norton, J.A.,Kivlen, M., Li, M., Schneider, D., Chuter, T. and Jensen, R.T. (2003) Morbidity and Mortality of Aggressive Resection in Patients with Advanced Neuroendocrine Tumors. Archives of Surgery, 138, 859-866.
http://dx.doi.org/10.1001/archsurg.138.8.859

[13]   Poultides, G.A. and Frederick, W.A. (2006) Carcinoid of the Ampulla of Vater: Morphologic Features and Clinical Implications. World Journal of Gastroenterology, 12, 7058-7060.

[14]   Hwang, S., Lee, S.G., Lee, Y.J., Han, D.J., Kim, S.C., Kwon, S.H., et al. (2008) Radical Surgical Resection for Carcinoid Tumors of the Ampulla. Journal of Gastrointestinal Surgery, 12, 713-717.
http://dx.doi.org/10.1007/s11605-007-0389-3

[15]   Oberg, K. (2004) Management of Neuroendocrine Tumours. Annals of Oncology, 15, iv293-iv298.

[16]   Oberg, K. and Eriksson, B. (2005) Nuclear Medicine in the Detection, Staging and Treatment of Gastrointestinal Carcinoid Tumours. Best Practice & Research. Clinical Endocrinology & Metabolism, 19, 265-276.
http://dx.doi.org/10.1016/j.beem.2004.11.016

[17]   Hochwald, S.N., Zee, S., Conlon, K.C., Colleoni, R., Louie, O., Brennan, M.F., et al. (2002) Prognostic Factors in Pancreatic Endocrine Neoplasms: An Analysis of 136 Cases with a Proposal for Low-Grade and Intermediate-Grade Groups. Journal of Clinical Oncology, 20, 2633-2642. http://dx.doi.org/10.1200/JCO.2002.10.030

[18]   Pyun, D.K., Moon, G., Han, J., Kim, M.H., Lee, S.S., Seo, D.W., et al. (2004) A Carcinoid Tumor of the Ampulla of Vater Treated by Endoscopic Snare Papillectomy. Korean Journal of Internal Medicine, 19, 257-260.

[19]   Sakka, N., Smith, R.A., Whelan, P., Ghaneh, P., Sutton, R., Raraty, M., et al. (2009) A Preoperative Score for Resected Pancreatic and Periampullary Neuroendocrine Tumors. Pancreatology, 9, 670-676.
http://dx.doi.org/10.1159/000181179

[20]   Jarufe, N.P., Coldham, C., Orug, T., Mayer, A.D., Mirza, D.F., Buckels, J.A., et al. (2005) Neuroendocrine Tumors of the Pancreas: Predictors of Survival after Surgical Treatment. Digestive Surgery, 22, 157-162.
http://dx.doi.org/10.1159/000087148

 
 
Top