Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report
Introduction: Ampullary neuroendocrine tumors (NETs) are usually diagnosed in the 5th–6th decades of life, and no cases were reported in <20 years of age. We report a rare case, presenting at a very young age, of well-differentiated NET involving the ampulla of Vater with lymph node metastasi...
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| Format: | Article |
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Karger Publishers
2024-04-01
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| Series: | Case Reports in Gastroenterology |
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| Online Access: | https://beta.karger.com/Article/FullText/538260 |
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| author | Jaafar Alsalman Abdulaziz Alquorain Mohammed Alyousef Omran Aldandan Ibrahim Alzahrani |
| author_facet | Jaafar Alsalman Abdulaziz Alquorain Mohammed Alyousef Omran Aldandan Ibrahim Alzahrani |
| author_sort | Jaafar Alsalman |
| collection | DOAJ |
| description | Introduction: Ampullary neuroendocrine tumors (NETs) are usually diagnosed in the 5th–6th decades of life, and no cases were reported in <20 years of age. We report a rare case, presenting at a very young age, of well-differentiated NET involving the ampulla of Vater with lymph node metastasis. Case Presentation: An 18-year-old man presented with a 3-month history of upper abdominal pain and jaundice. Abdominal ultrasound showed a dilated common bile duct, and endoscopic retrograde cholangiopancreatography revealed two duodenal polypoid lesions, one of them overlying the ampulla of Vater, with an erythematous and ulcerated surface. Histopathological examination confirmed the diagnosis of NET grade 1. Octreotide scan revealed 2 para-aortic lymph nodes with intense radiotracer uptake. The patient had undergone Whipple surgery with para-aortic lymph node dissection. Histopathological examination of the surgical specimens was confirmatory of NET grade 2 and paraganglioma in a few of the dissected lymph nodes. Postoperatively, the patient was kept on monthly intramuscular octreotide. Follow-up gallium-68 DOTATATE is unremarkable apart from an avid left para-aortic lymph node which is showing stability over 12 months of follow-up. Conclusion: This case demonstrates that NETs of the ampulla of Vater can present at a very young age. Radical surgical excision with extended lymph node dissection and postoperative octreotide is associated with better patient outcomes and survival. |
| first_indexed | 2024-04-24T07:54:29Z |
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| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-04-24T07:54:29Z |
| publishDate | 2024-04-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-7c1ad31070d344a7a9df80a6f18299b92024-04-18T07:17:48ZengKarger PublishersCase Reports in Gastroenterology1662-06312024-04-0118120421310.1159/000538260538260Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case ReportJaafar Alsalman0Abdulaziz Alquorain1Mohammed Alyousef2Omran Aldandan3Ibrahim Alzahrani4Department of Internal Medicine, Division of Gastroenterology, Dammam Medial Complex, Dammam, Saudi ArabiaDepartment of Internal Medicine, Division of Gastroenterology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaDepartment of Pathology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaDepartment of Radiology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaDepartment of Internal Medicine, Division of Gastroenterology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaIntroduction: Ampullary neuroendocrine tumors (NETs) are usually diagnosed in the 5th–6th decades of life, and no cases were reported in <20 years of age. We report a rare case, presenting at a very young age, of well-differentiated NET involving the ampulla of Vater with lymph node metastasis. Case Presentation: An 18-year-old man presented with a 3-month history of upper abdominal pain and jaundice. Abdominal ultrasound showed a dilated common bile duct, and endoscopic retrograde cholangiopancreatography revealed two duodenal polypoid lesions, one of them overlying the ampulla of Vater, with an erythematous and ulcerated surface. Histopathological examination confirmed the diagnosis of NET grade 1. Octreotide scan revealed 2 para-aortic lymph nodes with intense radiotracer uptake. The patient had undergone Whipple surgery with para-aortic lymph node dissection. Histopathological examination of the surgical specimens was confirmatory of NET grade 2 and paraganglioma in a few of the dissected lymph nodes. Postoperatively, the patient was kept on monthly intramuscular octreotide. Follow-up gallium-68 DOTATATE is unremarkable apart from an avid left para-aortic lymph node which is showing stability over 12 months of follow-up. Conclusion: This case demonstrates that NETs of the ampulla of Vater can present at a very young age. Radical surgical excision with extended lymph node dissection and postoperative octreotide is associated with better patient outcomes and survival.https://beta.karger.com/Article/FullText/538260ampulla of vaterlymph node metastasesneuroendocrine tumorpancreaticoduodenectomysmall intestinal |
| spellingShingle | Jaafar Alsalman Abdulaziz Alquorain Mohammed Alyousef Omran Aldandan Ibrahim Alzahrani Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report Case Reports in Gastroenterology ampulla of vater lymph node metastases neuroendocrine tumor pancreaticoduodenectomy small intestinal |
| title | Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report |
| title_full | Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report |
| title_fullStr | Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report |
| title_full_unstemmed | Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report |
| title_short | Obstructive Jaundice Caused by Metastatic Neuroendocrine Tumor of the Ampulla of Vater in a Young Adult: A Case Report |
| title_sort | obstructive jaundice caused by metastatic neuroendocrine tumor of the ampulla of vater in a young adult a case report |
| topic | ampulla of vater lymph node metastases neuroendocrine tumor pancreaticoduodenectomy small intestinal |
| url | https://beta.karger.com/Article/FullText/538260 |
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