A 69-year-old male patient presented with occasional melena since April 2006. He denied abdominal pain, vomiting, fever, weight loss, or jaundice. Except for mild pallor, the physical examination findings were essentially unremarkable.
His upper gastrointestinal endoscopy revealed a bulging ampulla of Vater that bled on touch (Figure 1). The biopsy specimen was suggestive of inflammatory cells. At contrast-enhanced computed tomographic scan of the upper abdomen, a heterogeneously enhancing tumor in the ampullary region was reported. For further characterization, endosonography (EUS) was performed (Figure 2).
Polypoid lesion at the ampulla of Vater.
Endosonography showing a hypoechoic lesion.
A. Neuroendocrine tumor
C. Gastrointestinal stromal tumor
D. Ampullary carcinoma
Singhal D, Kumar M, Sud R, Chaudhary A. Image of the Month—Quiz Case. Arch Surg. 2007;142(9):899. doi:10.1001/archsurg.142.9.899