The Small Cell Neuroendocrine Carcinoma Of The Ampulla Of Vater

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Seniors / Aging;  Men's health;  Cancer / Oncology
Article Date: 25 Sep 2008 - 4:00 PDT

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Ampullary small cell neuroendocrine carcinoma is extremely rare and has only been documented in a few case reports and retrospective study. The patients with ampullary small cell neuroendocrine carcinoma usually presented after the age of 60 years, and a male predilection was observed. Only two cases of a small cell neuroendocrine carcinoma associated with an adenoma have been described in a retrospective study. There has been no radiology report describing the imaging features of these coexisting tumors of the ampullary region.

An article published on August 7, 2008 in the World Journal of Gastroenterology addresses this report. The medical team composed of Dr. Sun JH and his colleagues from Second Affiliated Hospital and Sir Run Run Shaw Hospital, Zhejiang University revealed the novel case based on the clinical, histopathological and radiological features.

A 74-year-old man presented with a 3 week history of abdominal discomfort and jaundice. Abdominal ultrasonography, computed tomography (CT) and MR cholangiogram (MRCP) showed two well-defined masses in the ampullary region, dilated bile ducts and pancreatic duct, and peripancreatic lymphadenopathy. The patient underwent Whipple's operation with local lymph node dissection. Histopathology after the operation revealed the coexistence of a small cell neuroendocrine carcinoma and a villous adenoma in the ampulla of Vater. Unfortunately, the patient died of pneumonia 3 months after the operation.

The preoperative diagnosis of these rare tumors in the ampulla is potentially problematic. CT finding of a polypous mass with a long pedicle was helpful to diagnose an adenoma. However, it may not be possible to differentiating ampullary small cell neuroendocrine carcinoma from ampullary adenocarcinoma on CT. Thus, small cell neuroendocrine carcinoma should be included in the differential diagnosis of ampullary masses especially when the patient is an old male. These tumors' associations suggest a common origin in the ampulla of Vater. It is probable that the two neoplasms originate from non-neoplastic multipotent stem cells that terminally differentiate into all kinds of epithelial cells including ciliated cells, mucous cells and endocrine cells.

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Reference: Sun JH, Chao M, Zhang SZ, Zhang GQ, Li B, Wu JJ. Coexistence of small cell neuroendocrine carcinoma and villous adenoma in the ampulla of Vater. World J Gastroenterol 2008;14(29): 4709-4712 . http://www.wjgnet.com/1007-9327/14/4709.asp

Correspondence to: Dr. Ming Chao, Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China.

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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H pylori infection. It provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th of every month. The WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the title China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.

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Source: Lai-Fu Li
World Journal of Gastroenterology

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