Leonard J. Chabert Medical Center mississauga, ON, Canada
Nadish Ravindran, MD Leonard J. Chabert Medical Center, Houma, LA
Introduction: We present a rare case of worsening anxiety, leading to the work-up and diagnosis of a well differentiated neuroendocrine tumor of the ampulla of Vater.
Case Description/Methods: A 37-year-old black female with no significant past medical history was being evaluated for complaints of worsening anxiety. She stated that her anxiety was not situational and was paroxysmal in nature without an obvious stressor, and the duration of her attacks varied. She denied any skin flushing, diarrhea, frequent urination, increased thirst, dizziness, shakiness, hoarseness, cough, or jaundice She was noted to have a history of elevated liver function tests and alkaline phosphatase on laboratory testing. Her total bilirubin, prothrombin time and partial thromboplastin time were within normal limits. Extensive work-up was performed and found to be negative, including but not limited to; immunoglobulin A, celiac panel, hepatitis panel, human immunodeficiency virus, ceruloplasmin, AFP tumor marker, anti-mitochondrial antibody and anti-smooth muscle antibody. Ultrasound of the abdomen revealed a mildly dilated bile duct. Further evaluation with a magnetic resonance cholangiopancreatography study was performed and revealed prominent dilatation of the intrahepatic, extrahepatic and common bile ducts with a possible lesion at the ampulla of Vater. Endoscopic ultrasound with biopsy of the ampulla of Vater revealed a well differentiated neuroendocrine tumor. She was referred to surgery for removal of the malignancy.
Discussion: Neuroendocrine tumors involving the ampulla of Vater are rarely seen in clinical practice. The clinical presentation of this patient was relatively benign, however her labs consistently showed elevations which could not otherwise be explained. Due to the rarity of this malignancy in this location, it's imperative for physicians to be aware of how a patient could possibly present to avoid missing a potential diagnosis or ordering an imaging test which could lead to a diagnosis. This case highlights the lack of symptoms which can be exhibited by these patients; however, the random variable anxiety attacks she experienced can now be attributed to her underline malignancy.
Disclosures:
Nadish Ravindran indicated no relevant financial relationships.
Nadish Ravindran, MD. E0667 - A Unique Case of Paroxysmal Anxiety Leading to the Diagnosis of a Rarely Seen Neuroendocrine Tumor at the Ampulla of Vater, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
