2 33 Figure 1: Hydropic gallbladder and choledoc dilation were seen on tomographic examination, Yet any mass appearance or lymph node was not encountered. Figure 2: Papilla that was tumor-like macroscopically was seen in endoscopic retrograde cholangio pancreatography. in the patient who was diagnosed as a well-diﬀerentiated endocrins tumor on histopathologic evaluation. Adjuvant chemotherapy and biologic treatment were not planned because of the absence of carcinoid syndrome ﬁndings and poor prognostic histopathologic properties. 3. Discussion Ampullary located carcinoid tumor was ﬁrst described by Oberndorfer in 1907 [2]. Although most of the reports are comprised of case reports, approximately 120 cases have been reported to date. It is rarer than even duodenal involvement deﬁned as rare (2%) with this number (0.05%) [3, 4]. Its clinical presentation is composed of jaundice (53,1%), abdominal pain (24,6%), pancreatitis (6,0%), and weight loss (3,6%) [1–4]. Abdominal tomography and endoscopic Case Reports in Medicine Figure 3: Specimens were stained synaptophysin (+), chromo- granin-A (+), Ki–67 2% (+) in immunohistochemical staining. imaging methods are also valuable besides clinical ﬁndings for making a diagnosis. Of endoscopic imaging methods, especially endoscopic retrograde cholangio pancreatography, endoscopic biopsy and endosonographic ultrasonography may be used for the detection of invasion depth [5]. In 25% of ampullary carcinoid tumors, they are seen to be related with von Recklinghausen syndrome and MEN syndromes. Additionally, most of the ampullary tumors have been seen to be positive in terms of somatostatin in pathologic exami- nation. Thus octreotide scintigraphy is used with the aim of screening [6]. For carcinoid tumors with unknown malignity potential, a novel classiﬁcation system was developed by the World Health Organization which classes tumors as benign, potentially malignant and malignant. In this classiﬁcation, tumor proliferative index, invasion depth, and anatomic location were evaluated [7, 8]. Ampullary carcinoid tumors still have obscurities about the issues like prognostic features, invasion depths, and lymph node metastasis because of its prevalence [9]. These obscurities also reﬂect on surgical treatment strategy of ampullary carcinoid tumors. Makhlouf et al. stated that metastatic disease was not in question for duodenal carcinoid tumors smaller than 20 mm, whereas the same may not be said for ampullary carcinoid tumors. In literature, the presence of metastatic disease was seen in 40– 50% of ampullary carcinoid cases smaller than 20 mm. Thus it is advocated that the most appropriate surgical treatment option should be the Whipple procedure [9, 10]. In our case, metastasis of lymph node was found although the tumor size was below 20 mm, and all signs were not marked by the CT scan. Today, with the knowledge gained from oncologic surgical interventions, pancreatico- duodenectomy has become routinely practicable without any complications, which was inconceivable in the past. Therefore, we consider that, the most appropriate surgical treatment option for ampullary carcinoid tumors must be the Whipple procedure. Hwang et al. detected one-year survey as 90% and three-year survey as 64% in 10 patients who underwent pancreaticoduodenectomy with a mean tumor size of 2.1 ± 1.3 cm [11].