Case Reports in Medicine The opponent group states that lymph node dissection does not have a therapeutic eﬀect on ampullary carcinoid tumors and thus recommends local excision or endoscopic resection with lower morbidity and mortality [12, 13]. However, as described by Clement et al., the possibility of residual tumoral formation is high with local resection, just as in the case that showed local recurrence 20 months after local excision [14]. These ﬁndings indicate that tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors. Adjuvant treatment options should be planned by taking prognostic factors of tumor and carcinoid syndrome ﬁndings into consideration. Adjuvant chemother- apy may be administered following resection in tumors that have poor prognostic factors. The most commonly used agents for chemotherapy are streptozocin, doxorubicin, dacarbazine, and 5-ﬂuorouracil. Other treatment options are biologic therapy (interferon INF, somatostatin analogues SST) and chemoembolization [13, 14]. 4. Conclusion Gastrointestinal system-related deaths are placed highly among cancer-related deaths. Hepatobiliary system cancers are the most feared tumors among all gastrointestinal system tumors with a prevalence of 7–300/100.00 [15]. The only known potential therapeutic treatment option for these cancers is surgical RO resection. The presence of lymph node metastasis and tumor size is known as an independent prognostic factor for hepatobiliary cancers. However, tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors. Conﬂict of Interest The authors do not have any ﬁnancial relationship with the organization that sponsored the research. References [1] M. Hartel, M. N. Wente, B. Sido, H. Friess, and M. W. B u¨chler, “Carcinoid of the ampulla of Vater,” Journal of Gastroenterology and Hepatology, vol. 20, no. 5, pp. 676–681, 2005. [2] S. Oberndorfer, “Karzinoide Tumoren des Dunndarms,” Frank- furter Zeitschrift fur Pathologie, vol. 1, pp. 426–432, 1907. [3] E. Hatzitheoklitos, M. W. Buchler, H. Friess et al., “Carcinoid of the ampulla of Vater: clinical characteristics and morpho- logic features,” Cancer, vol. 73, no. 6, pp. 1580–1588, 1994. [4] J. Waisberg, L. L. De Matos, D. R. Waisberg, H. V. B. Dos Santos, S. M. Fernezlian, and V. L. Capelozzi, “Carcinoid of the minor duodenal papilla associated with pancreas divisum: case report and review of the literature,” Clinics, vol. 61, no. 4, pp. 365–368, 2006. [5] F. Luka, I. Sze´kely, C. Ma´j, I. Sza´nto´ , B. Hamvas, and A. Altorjay, “Carcinoid tumor of the papilla of Vater,” Magyar Seb´eszet, vol. 58, no. 5, pp. 320–323, 2005. [6] N. E. Koc¸er, F. Kayaselc¸uk, K. C¸ alis¸kan, and S¸ . Ulusan, “Synchronous GIST with osteoclast-like giant cells and a well-diﬀerentiated neuroendocrine tumor in Ampula Vateri: 3 coexistence of two extremely rare entities,” Pathology Research and Practice, vol. 203, no. 9, pp. 667–670, 2007. [7] E. K. G. Solcia and L. H. Sobin, Histological Typing of Endocrine Tumors, Springer, Heidelberg, Germany, 2000. [8] G. Klo¨ppel, P. U. Heitz, C. Capella, and E. Solcia, “Pathology and nomenclature of human gastrointestinal neuroendocrine (carcinoid) tumors and related lesions,” World Journal of Surgery, vol. 20, no. 2, pp. 132–141, 1996. [9] I. M. Modlin, M. Kidd, I. Latich, M. N. Zikusoka, and M. D. Shapiro, “Current status of gastrointestinal carcinoids,” Gastroenterology, vol. 128, no. 6, pp. 1717–1751, 2005. [10] H. R. Makhlouf, A. P. Burke, and L. H. Sobin, “Carcinoid tumors of the ampulla of vater: a comparison with duodenal carcinoid tumors,” Cancer, vol. 85, no. 6, pp. 1241–1249, 1999. [11] S. Hwang, S. G. Lee, Y. J. Lee et al., “Radical surgical resection for carcinoid tumors of the ampulla,” Journal of Gastrointestinal Surgery, vol. 12, no. 4, pp. 713–717, 2008. [12] D. K. Pyun, G. Moon, J. Han et al., “A carcinoid tumor of the ampulla of vater treated by endoscopic snare papillectomy,” Korean Journal of Internal Medicine, vol. 19, no. 4, pp. 257– 260, 2004. [13] J. L. Ricci, “Carcinoid of the ampulla of Vater: local resection or pancreaticoduodenectomy,” Cancer, vol. 71, no. 3, pp. 686– 690, 1993. [14] W. M. Clements, S. P. Martin, G. Stemmerman, and A. M. Lowy, “Ampullary carcinoid tumors: rationale for an aggres- sive surgical approach,” Journal of Gastrointestinal Surgery, vol. 7, no. 6, pp. 773–776, 2003. [15] C. F. Garland, F. C. Garland, and E. D. Gorham, “Etiology. Epidemiology end potantial prevention of the gastrointestinal cancer,” in Surgery for Gastrointestinal Cancer, H. J. Wanebo, Ed., pp. 3–22, Lippincott-Raven, Philadelphia, Pa, USA, 1997.