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Special Feature
September 1, 2007

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations:Departments of Surgical Gastroenterology (Drs Singhal and Chaudhary) and Hepatology and Gastroenterology (Drs Kumar and Sud), Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India.



Arch Surg. 2007;142(9):899. doi:10.1001/archsurg.142.9.899

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).

Figure 1.
Polypoid lesion at the ampulla of Vater.

Polypoid lesion at the ampulla of Vater.

Figure 2.
Endosonography showing a hypoechoic lesion.

Endosonography showing a hypoechoic lesion.

What Is the Diagnosis?

A. Neuroendocrine tumor

B. Lymphoma

C. Gastrointestinal stromal tumor

D. Ampullary carcinoma