P-0122 - Ampullary neuro-endocrine tumour: Clinicopathological features, treatment and prognosis
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Neuroendocrine Cancers
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
R. Singh1, R. Saxena1, N. Kripalani1, D. Neeraj1, R. Singh1, A. Prakash1, A. Behari1, A. Kumar2, V. Kapoor1
Ampullary neuro-endocrine tumours are very uncommon. Preoperative diagnosis is difficult since they present with similar clinical pictures to ampullary adenocarcinoma. Final diagnosis is based on histology.
A retrospective analysis of patients treated at tertiary care center over 10 year from 2003-2012 is done to review the clinic-pathological feature and treatment options for ampullary neuro-endocrine tumour.
A total 10 cases of ampullary neuro-endocrine were confirmed on histology. Mean age of presentation was 44 yr (18 – 63 yrs). Most common presentation was weight loss in 6 patients (60%), pruritus in 5 patients (50%), pain abdomen and jaundice in 4 patients (40%). No functional syndrome was identified in any patient. Pre-operative endoscopic biopsy was taken in 7 patients and reported as adenocarcinoma (3), neuro-endocrine tumour (2), adenomatous polyp (1) and benign (1). Preoperative biliary stenting was done in 4 patients. Resection was done in all – Pancreaticoduodenectomy (PD) in 8 and Ampullectomy with lymphadenectomy (A&L) in 2 patients. Of the PD-group the morbidity included pancreatic anastomotic leak (1), delayed gastric emptying (1) and hemorrhage (1). Of the A&L-group one patient had delayed gastric emptying. The mean hospital stay was 15 days (9-30) for the PD-group and 18 days (15-21) for the A&L-group. The Mean tumour size was 2.85 cm (1.5 – 4.0 cm). Nodal metastases were present in 3 patients. The final pathologic stage was – IIA (4), IIB (3) and IIIB (3). Immunohistochemistry data was available in 9 patients and were positive for Synaptophysin (9) and for Chromogranin (8). The mean follow up was 22 months (5-55). Two patients (PD-group) developed diffuse liver metastasis at 2 months and 6 months and died. One patient had features of chronic pancreatitis at 4 yrs follow up. The other 7 patients are well and disease free at last follow-up.
Neuroendocrine tumours are rare tumours at the ampullary region. These are mostly nonfunctional and presentation is similar to the periampullary adenocarcinoma. Pre-operative histologic diagnosis is difficult. Pancreaticoduodenectomy is the treatment of choice, but ampullectomy can be considered in localized small tumours.