Mixed neuroendocrine-nonneuroendocrine neoplasm of the ampulla: Four case reports

Table 1 Imaging, duodenal endoscopy and biopsy, laboratory, pathological and immunohistochemical examinations of 4 patients.

Serial number	Image	Duodenal endoscopy and biopsy	Tumor markers	Ratio (%); ADC:NEN	Immunohisto-chemistry	Ki-67
Patient 1	Enhanced CT	No	CA19-9 rise; CEA, AFP normal	30:70	Component (NEN): CgA(-), Syn(+), CD56(+)	30%
Patient 2	Enhanced MRI	Yes, ADC	CA19-9, CEA, AFP normal	60:40	Component (NEN): CgA(+), Syn(+), CD56(+)	50%
Patient 3	Enhanced MRI	Yes, ADC	CA19-9 rise; CEA, AFP normal	60:40	Component (NEN): CgA(+/-), Syn(+), CD56(+)	70%
Patient 4	Enhanced CT	No	CA19-9, CEA, AFP normal	40:60	Component (NEN): CgA(-), Syn(+), CD56(+)	70%

AFP: Alpha fetal protein; CT: Computed tomography; CA19-9: Carbohydrate antigen199; CEA: Carcinogenic embryonic antigen; MRI: Magnetic resonance imaging.

Table 2 Treatment and follow-up data of 4 patients

Serial number	Sex	Age	First symptoms	Treatment	Chemo-therapy	Follow-up	Postoperative overall survival (mo)
Patient 1	Male	81	Jaundice	Pancreatico-duodenectomy	No	Death	1
Patient 2	Male	69	Jaundice	Pancreatico-duodenectomy	Yes	Death	29
Patient 3	Male	67	Abdominal pain	Pancreatico-duodenectomy	Yes	Death	22
Patient 4	Male	72	Jaundice;Abdominal pain	Pancreatico-duodenectomy	Yes	Survival	-