Hindawi Publishing Corporation Case Reports in Medicine Volume 2011, Article ID 173036, 3 pages doi:10.1155/2011/173036 Case Report The Rare Malignancy of the Hepatobiliary System: Ampullary Carcinoid Tumor Mustafa Ozsoy,1 Yucel Ozsoy,1 Aras Emre Canda,2 Olcay Ak Nalbant,3 and Fatih Haskaraca4 1 Department of General Surgery, Manisa State Hospital, 45000 Manisa, Turkey 2 Department of General Surgery, Dokuz Eylul University School of Medicine, Izmir, Turkey 3 Department of Pathology, Manisa State Hospital, Manisa, Turkey 4 Department of General Surgery, Merkezefendi State Hospital, Manisa, Turkey Correspondence should be addressed to Mustafa Ozsoy, dr.mustafaozsoy@gmail.com Received 4 February 2011; Revised 9 April 2011; Accepted 12 April 2011 Academic Editor: Robert A. Kozol Copyright © 2011 Mustafa Ozsoy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Carcinoid tumors are low-grade tumors originating from endoderm and mostly involving the gastrointestinal system. However; they may be seen in any site within the gastrointestinal system. Case Presentation. A 69-year-old female patient. The results of blood tests were observed to be consistent with obstructive jaundice. A mass appearance was not encountered on tomographic examination. Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in diagnostic endoscopy. Pylorus—preserving pancreaticoduodenectomy surgical procedure was applied. On pathological examination of the mass, a tumoral mass was detected in ampulla vateri localization, 1.5 × 1 × 0.8 cm in size, which, in immunohistochemical staining, was evaluated as a neuroendocrine tumor. Also, Metastasis was observed. Conclusion. The rarest type of carcinoid tumor is ampullary located carcinoid tumor, and tumor size is not a reliable indicator for tumor aggressivity in ampullary carcinoid tumors. 1. Introduction Carcinoid tumors are low-grade tumors originating from endoderm and mostly the involving gastrointestinal system. Although they may be seen at any site in the whole gastrointestinal system, the most commonly involved areas are appendix, distal small intestine, rectum, and stomach [1]. Herein, we described the rarest type of carcinoid tumor. 2. Case Report A 69-year-old female patient was examined as jaundice was added to abdominal pain, accompanied by intermittent emesis and vomiting, lasting for 3 months. Results of blood tests were observed to be consistent with obstructive jaundice. A mass appearance was not encountered on tomographic examination obtained with prediagnosis of pancreatic cancer due to hydropic gallbladder and choledoc dilation on abdominal ultrasonography (Figure 1). Papilla that was tumor-like macroscopically was seen in the second part of the duodenum in diagnostic endoscopy (Figure 2). The patient, whose endoscopic biopsy result was evaluated as a well-diﬀerentiated endocrine tumor, was operated on. An ovoid mass 2 × 2 cm in size was detected in ampulla vateri in intra-abdominal exploration. Pylorus—preserving pan- creaticoduodenectomy surgical procedure was applied to the patient as the mass did not make vascular invasion but local invasion. The patient in whom a major surgical complication was not observed in postoperative followup was discharged in the postoperative second week. On pathologic examina- tion of the mass, a tumoral mass was detected in ampulla vateri localization, 1.5 × 1 × 0.8 cm in size, and invaded submucosa and muscularis propria. The patient whose specimens were stained synaptophysin (+), chromogranin-A (+), and Ki-67 2% (+) in immunohistochemical staining was evaluated as a neuroendocrine tumor (Figure 3). Metastasis was observed in one out of 10 lymph nodes that were sorted out in the peripancreatic region of the patient whose surgical margins were healthy. No other foci were encountered in octreotide scintigraphy in the postoperative ﬁrst month