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Neuroendocrine tumor of the ampulla of Vater showing chronological endoscopic changes

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Abstract

We report a rare case of neuroendocrine tumor of the ampulla of Vater in a 53-year-old Japanese male. The patient was admitted to our institution for workup of presyncope secondary to anemia. Medical history was pertinent for coronary artery disease, for which he had drug eluting stents (DES) placed and was on aspirin and clopidogrel therapy. Upper endoscopic evaluation revealed bleeding from an erosion at the ampulla of Vater. Endoscopic therapy with epinephrine and thrombin injection allowed for successful hemostasis and repeat endoscopy 6 months later did not show any changes in lesion character. Repeat endoscopy at 1 year, however, revealed erythema and further erosion on the ampulla of Vater as the lesion had progressed. The patient was diagnosed with carcinoma of the ampulla of Vater. Abdominal computed tomography showed a 9-mm hypervascular tumor at the ampulla of Vater and the patient underwent open pancreatoduodenectomy and lymphadenectomy. Histologically, the tumor consisted of small-sized round cell proliferations with a solid nest pattern. Immunostaining results indicated that the tumor cells were positive for synaptophysin and 2.5% were positive for Ki-67. The final diagnosis was sporadic non-functional neuroendocrine tumor (NET) G1 of the ampulla of Vater. This case demonstrates that NET of the ampulla of Vater, while rare, can have significant changes and growth over time and highlights the importance of follow-up endoscopic evaluations.

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Acknowledgements

We do not have any financial interest in the subject matter connected with our case report.

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Authors and Affiliations

  1. Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho Kita-ku, Okayama-city, 700- 8511, Japan

    Masakuni Fujii, Yuki Okamoto, Shinichi Fujioka, Masao Yoshioka & Junji Shiode

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  1. Masakuni Fujii
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  2. Yuki Okamoto
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  3. Shinichi Fujioka
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  4. Masao Yoshioka
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Correspondence to Masakuni Fujii.

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Masakuni Fujii, Yuki Okamoto, Shin-ichi Fujioka, Masao Yoshioka and Junji Shiode declare that they have no conflict of interest.

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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Fujii, M., Okamoto, Y., Fujioka, S. et al. Neuroendocrine tumor of the ampulla of Vater showing chronological endoscopic changes. Clin J Gastroenterol 15, 205–209 (2022). https://doi.org/10.1007/s12328-021-01553-w

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  • DOI: https://doi.org/10.1007/s12328-021-01553-w

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