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Copyright ©The Author(s) 2016.
World J Gastroenterol. Jan 14, 2016; 22(2): 600-617
Published online Jan 14, 2016. doi: 10.3748/wjg.v22.i2.600
Figure 4
Figure 4 A 55-year-old woman was found to have an ampullary mass on upper endoscopy for abdominal pain. Magnetic resonance imaging showed an ampullary tumor with no locoregional invasion or hepatic metastases. Mucosal biopsies showed no pathologic abnormality. The patient was referred for endoscopic ultrasonography (EUS) and possible ampullectomy. On duodenoscopy, a large, irregular ampulla was seen with a whitish hue at the ampullary os (A); EUS demonstrated a 1.6-cm, round, hypoechoic ampullary mass that did not invade into the muscularis propria or into the pancreas (B); On attempted hot-snare resection (C), the lesion was very hard and the snare slipped off the lesion resecting only the surface mucosa, which revealed a white ampullary carcinoid tumor. Ampullectomy was aborted, a biliary sphincterotomy was performed, and a prophylactic pancreatic duct stent was placed (D); Histopathology showed nests of neoplastic cells that stained strongly with antibodies to chromogranin (immunoperoxidase × 20) that extend from the surface epithelium (top and to the right), which confirmed a carcinoid tumor (E). The patient underwent pancreaticoduodenectomy with a curative (R0) resection and no lymph node metastases.