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noid tumors diagnosed and appropriately staged by EUS-FNA. In case 1, a 46-year-old man presented with anemia and a 4.5-kg weight loss. Laboratory analysis showed: hemoglobin 11.2mg/dL, total bilirubin 1.4mg/dL, alkaline phosphatase 324 U/L, aspartate aminotransferase (AST) 221 U/L, and alanine aminotransferase (ALT) 205 U/L. Colonoscopy was unremarkable. Upper endoscopy showed an enlarged and ulcerated ampulla (●" Fig. 1). Mucosal biopsies showed non-specific inflammatory changes. Abdominal computed tomography (CT) disclosed dilation of the main pancreatic duct and the intrahepatic and extrahepatic biliary ducts. Endoscopic ultrasound (EUS) revealed a round hypoechoic 26-mm ampullary subepithelial mass, staged as T2N1Mx (●" Fig. 2). The pancreatic duct and bile duct were dilated up to 4mm and 8mm respectively. Fine needle aspiration (FNA) showed atypical cells with round, eccentric nuclei, suggestive of a low grade neuroendocrine tumor. Immunostains for synaptophysin and chromogranin Awere positive. The patient underwent pancreaticoduodenectomy. Surgical pathology confirmed a T2N1M0 carcinoid tumor (●" Fig. 3). Imaging and clinical follow-up at 6 months were unremarkable. In case 2, a 53-year-old woman presented with painless jaundice and a 9-kg weight loss. Physical examination revealed scleral icterus and mild non-tender hepatomegaly. Laboratory analysis showed: total bilirubin 5.9mg/dL, alkaline phosphatase 405 U/L, AST 96 U/L, and ALT 190 U/L. Abdominal CT showed a dilated pancreatic duct and intrahepatic and extrahepatic biliary ducts. Endoscopy revealed an 18-mm ampullary subepithelial lesion, staged on EUS as T3N1Mx (●" Fig. 4 and ●" Fig. 5). The pancreatic duct and common bile duct were dilated up to 5mm and 13mm Ampullary carcinoid tumors diagnosed by endoscopic ultrasound-guided fine needle aspiration in two patients with biliary and pancreatic duct obstruction

endoscopy

Ampullary carcinoid tumors diagnosed by endoscopic ultrasound-guided fine needle aspiration in two patients with biliary and pancreatic duct obstruction