Sok Kyun Hong, et al : A case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms :, 57 : : kg. :, 1998 l. :. :, 110/70 mmh

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1 : Carcinoid 1, *, * = A bs tra c t= A cas e of carcinoid tumor of ampulla of v ater pres enting as as thmatic s y mptoms Sok Kyun Hong, M.D., Im Hw an Roe, M.D., Myung In Lee, M.D., Sang Hyun Park, M.D., Jeung Hee Cho, M.D.* and Jung T aik Kim, M.D. Department of Internal M edicine, Pathology* and General Surgery Dankook University College of M edicine, Chunan, K orea The carcinoid tumor of the ampulla of Vater is extremely rare. We report a case of 57- year old male with carcinoid tumor of ampulla of Vater. T his patient had been presented with bronchial asthma for one year. Abdominal CT finding revealed diffuse dilatation of common bile duct and pancreatic duct, and also ampullary soft mass protruded into duodenal lumen. The correct diagnosis was made preoperatively by endoscopic retrograde cholangiography with biopsy. Pancreaticoduodenectomy with lymph nodes dissection was performed. Malignant carcinoid tumor originating from ampulla of Vater was diagnosed with pericholedochal lymphatic metastasis. Surgical removal led to complete resolution of asthmatic symptoms.(korean J Med 59: , 2000) Key Words : Carcinoid tumor; Vater's ampulla; Asthma (carcinoid tumor of the Ampulla of Vater) carcinoid 1% 1), carcinoid (duodenal carcinoid tumor), 2). carcinoid,, carcinoid. carcinoid 0.5-2cm 15%. 3). carcinoid , carcinoid 1. : : :, 16-5, ( ) nayana@anseo.dankook.ac.kr

Sok Kyun Hong, et al : A case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms :, 57 : : 57 6 5 kg. :, 1998 l. :. :, 110/70 mmhg, 84 /, 20 / 36.7.,.,.,,,.,,. : 7,070/ mm3( 66.

$CEA 166.01 ng/ml.. EF(ejection fraction) 63%. 245- HIAA 5.8 mg/day. FEV1: 96.5%, FVC: 85.8%, FEV1/FVC: 92.8%. FEV1 21%. :.. 2 (Figure 1). :, 2 2 cm (Figure 2).. (Figure 3). : carcinoid. 2.3 2.$

2 Sok Kyun Hong, et al : A case of carcinoid tumor of ampulla of vater presenting as asthmatic symptoms :, 57 : : kg. :, 1998 l. :. :, 110/70 mmhg, 84 /, 20 / 36.7.,.,.,,,.,,. : 7,070/ mm3( 66.2%, 21.3%, 6.1%, 5.2%), 14.4 g/dl. 1,559,000/mm3 1..,. AST 18 IU/L, ALT 12 IU/L, alkaline phosphatase 92 IU/L, 6.9 g/dl, 4.1 g/dl, 159 mg/dl, 0.48 mg/dl, - GT 18 IU/L, 118 mg/dl, BUN 10.2, Cr CEA ng/ml.. EF(ejection fraction) 63% HIAA 5.8 mg/day. FEV1: 96.5%, FVC: 85.8%, FEV1/FVC: 92.8%. FEV1 21%. :.. 2 (Figure 1). :, 2 2 cm (Figure 2).. (Figure 3). : carcinoid cm Figure 1. Abdominal CT scan shows 2 cm- sized, relatively well marginated soft tissue mass protruding into duodenal lumen in the second portion of duodenum (arrow). Figure 2. Duodenoscopic finding reveal 2 2 cm- sized polypoid mass resemble submucosal tumor in the ampulla of Vater

대한내과학회지 : 제 59 권 제 2 호 통권 제 480 호 2000 Fig ure 4.

ovoid mass encasing orifice of the ampulla of Vater. Fig ure 3.

common bile duct and intrahepatic bile duct dilatation. Figure 5.

Microscopic finding show s multiple tumor cell nests composed of

submucosal layer(h&e s tain, 200, A) and high magnifing pow

3 대한내과학회지 : 제 59 권 제 2 호 통권 제 480 호 2000 Fig ure 4. Gros s finding of operative s pecimen s hows a 2 2 cm- sized, ovoid mass encasing orifice of the ampulla of Vater. Fig ure 3. A cholangiopancreatogram show s a abrupt distal narrow ing of the common bile duct and intrahepatic bile duct dilatation. Figure 5. A Figure 5. B Figure 5. C Fig ure 5. A, B. Microscopic finding show s multiple tumor cell nests composed of monotonous small cells w ith eosinophilic cytoplas m in submucosal layer(h&e s tain, 200, A) and high magnifing pow er(h&e stain, 400, B). C. Immunohistochemical s taining s hows positive immunoreactivity for chromogranin A( 100)

4 5 : Carcinoid 1 pylorus preserving pancreaticoduodenctomy. : 2 2 cm (Figure 4)., (insular pattern) (tubular pattern) carcinoid (Figure 5A, B). carcinoid. chromogranin A (Figure 5C),,. Neuron specific enolase(nse). p53 5%. : hydroxyurea. Carcinoid (neuroendocrine cells) neuronspecific endolase(nse), synaptophysin, chromogranin 4). Carcinoid,,,,, 5), carcinoid 6). Carcinoid 77 2) ) 1. carcinoid 2:1 1). carcinoid 2), 40%, 10%, 1, 2). alkaline phosphatase. carcinoid carcinoid carcinoid. Carcinoid carcinoid,, 1). Carcinoid HIAA(5- hydroxyi- ndoleacetic acid), HIAA., carcinoid carcinoid. carcinoid carcinoid 25% 1 (von Recklinghausen' s disease) 1,2), carcinoid. - 8) carcinoid 9). carcinoid carcinoid,, 2), carcinoid, 2 cm, (mitotic activity) carcinoid, 10). carcinoid somatostatin, serotonin, cholecystokinin, insulin glucagon gastrin carcinoid gastrin

5 Korean Journal of Medicine : Vol. 59, No. 2, ). Carcinoid (nucleolus),, (insular pattern), (trabecular pattern), (glandular pattern), (undifferentiated pattern), (mixed pattern). chromogranin A NSE, synaptophysin, cytokeratin 100% 11). carcinoid,, 12). 1 carcinoid. carcinoid 13),,. carcinoid carcinoid 5 90%. 57 carcinoid, carcinoid. carcinoid. RE F E R E N C E S 1) Hatzitheoklitos E, Buechler MW, Friess H, Poch B, Ebert M, Mohr W. Imaizumi T, Beger HG. Carcinoid of the ampulla of Vater : Clinical characteristics and morpholo- gic features. Cancer 73: , ) Makhlouf HR, Burke AP, Sobin LH. carcinoid tumors of the am pulla of Vater : A comparison with duodenal carcinoid tumors. Cancer 15;85: , ) Buck JL, Elsayed AM. Ampullary tumors : radiologic pathologic correlation. Radiographics 13: , ) Matthew HK, Robert JM. carcinoid tum ors. N Engl J M ed 18: , Gabos S, Berkel J, Band P, Robson D, Whittaker H. Small bowel cancer in western canada. Int J Epidem iol 22: , ) Sabback MS, O' Brien PH. Clinical study of 81 gastrointestinal carcinoid tumors. South M ed J 72(4): , ),,,,,,,,,. carcinoid 1. 17:69-71, ) Perrone T. Duodenal gangliocytic paragangliom a and carcinoid. Am J Pathol 10: , ) Klein A, Clemens J. Periampullary neoplasms in von Recklinghausen's disease. Surgery 206: , ) Burke AP, Fedrspiel BH, Sobin LH, Shekitka KM, Helwig EB. carcinoids of the duodenum : A histologic and immunohistochemical study of 65 tumors. Am J Surg Pathol 13: , ) Bisceglia M, Giordano M, Bosman C. A rgyrophilnegative G- cell duodenal carcinoid Am J Gastroenterol 87: , ) Burke AP, Sobin LH, Federspiel BH, Shekitka KM, Helwig EB. Carcinoid tum ors of the duodenum. A clinicopathologic study of 99 case. A rch Pathol Lab M ed 114: , ) Asbun HJ, Rossi RL, Munson JL. Local resection for ampullary tumors. Is there a place for it? Arch Surg 128: ,

388 The Korean Journal of Hepatology : Vol. 6. No COMMENT 1. (dysplastic nodule) (adenomatous hyperplasia, AH), (macroregenerative nodule, MR

388 The Korean Journal of Hepatology : Vol. 6. No COMMENT 1. (dysplastic nodule) (adenomatous hyperplasia, AH), (macroregenerative nodule, MR 6 3 2000 ; 387-392 (3) Dysplastic Nodule Young Nyun Park, M.D., Chanil Park, M.D. Department of Pathology, Yonsei University College of Medicine BRIEF HISTORY 56. AST/ALT 72/73 IU/L, total bilirubin 0.7