Primary carcinoma of the duodenal minor papilla

Endoscopic papillectomy for tumors of the minor duodenal papilla: A case series of six patients and literature review

BACKGROUND/PURPOSE

Various tumors of the minor duodenal papilla have been reported, most of which are treated by laparotomy. Although early-stage tumors of the major papilla are increasingly being treated by endoscopic resection with relative ease and low invasiveness, there are only a few reports on endoscopic resection of tumors in the minor papilla.

METHODS

Six patients with tumors in the minor papilla were treated by endoscopic papillectomy (EP), and their clinical and histopathological data were analyzed retrospectively.

RESULTS

The final pathological diagnoses were carcinoma in adenoma in two patients and adenoma, neuroendocrine neoplasm (G1), hyperplastic lesion, and no neoplastic lesion (disappearance of adenoma after biopsy) in one patient each. En bloc resection was performed in five patients and piecemeal resection in one patient. There were no procedure-related adverse events, such as bleeding, pancreatitis, or perforation. There was one case with a residual lesion, which was treated by ablation therapy, and no recurrences during a mean follow-up of 12 ± 10.33 months (maximum, 28 months) from the date of EP.

CONCLUSIONS

Endoscopic papillectomy appears to be an effective minimally invasive treatment for ampullary tumors of the minor duodenal papilla.

Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy

We herein report an extremely rare case of adenocarcinoma of the minor duodenal papilla (MiDP) which was successfully treated by endoscopic mucosal resection (EMR). An asymptomatic 84-year-old man underwent upper gastrointestinal endoscopy, which revealed a slightly elevated lesion at the MiDP. The biopsy findings were suggestive of adenocarcinoma. Computed tomography, magnetic resonance images and endoscopic ultrasonography did not reveal pancreatic tumor infiltration nor any apparent distant metastases. Therefore, we treated the lesion using EMR with complete resection. No recurrence or metastasis has been detected at 13 months after EMR. Total resection of the MiDP can thus serve as a relatively safe and simple treatment.

A Case of Endoscopic Mucosal Resection of Carcinoma in Adenoma at the Minor Duodenal Papilla

Here, we describe a case of minor papillary adenocarcinoma in adenoma that was treated with endoscopic mucosal resection (EMR). In a 67-year-old woman, sigmoid colon cancer was incidentally detected on preoperative upper gastrointestinal endoscopy. Endoscopy revealed a slightly elevated lesion at the minor duodenal papilla. The findings of a histopathologic examination were suggestive of adenocarcinoma. Computed tomography and magnetic resonance images identified a minute tumor, whereas endoscopic ultrasonography revealed that the tumor did not spread to the pancreas. We performed EMR of this lesion. There were no complications, and relapse has not occurred in 3 years. Cases of minor papillary adenocarcinoma treated with EMR are quite rare.

A case of carcinoma in an adenoma of the duodenal minor papilla successfully treated with endoscopic mucosal resection

Endoscopic papillectomy is currently used to treat noninvasive tumors of the papilla of Vater, but it is seldom reported for treatment of similar tumors of the minor papilla. This report describes the case of a 69-year-old female with a tumor located at the duodenal minor papilla. Findings of duodenoscopy, biopsy, and pancreatography indicated that her noninvasive tumor of the minor papilla was suitable for treatment with endoscopic resection. Glycerol-injected endoscopic mucosal resection (EMR) was performed, and the resected material histologically showed carcinoma in the adenoma, negative for neoplastic extension at the cut margin. No complications occurred during the treatment course, and no recurrence has been recognized for 80 months. Unlike the major papilla of Vater, the minor papilla can be lifted up by submucosal injection. Noninvasive epithelial tumors of the duodenal minor papilla without extension to the pancreatic duct can be successfully treated with EMR, as the technique is easy, it is minimally invasive, and it is curative.

Primary adenocarcinoma of the minor duodenal papilla with mass-forming chronic pancreatitis: report of a case

A 70-year-old male was treated for gastric ulcers. Follow-up upper gastrointestinal endoscopy revealed an irregular, elevated tumor in the second portion of the duodenum. Upon pathological inspection of a biopsy specimen, a diagnosis of adenocarcinoma was made, and the patient was admitted to our hospital. Computed tomography showed an irregular mass in the pancreatic head and dilatation of the main pancreatic duct and bile duct. Pancreatic head carcinoma with infiltration of the duodenum was diagnosed, and pylorus-preserving pancreaticoduodenectomy was performed. A histopathological examination of the resected specimen showed moderately differentiated adenocarcinoma in the minor duodenal papilla and chronic pancreatitis in the pancreatic head. Therefore, primary adenocarcinoma of the minor duodenal papilla with mass-forming chronic pancreatitis was diagnosed. Currently, the patient is alive without recurrence 17 months after the surgery. Primary adenocarcinoma of the minor duodenal papilla is extremely rare. We herein report this case, and also provide a review of the literature.

Adenocarcinoma of the minor duodenal papilla: report of a case

We report a rare case of adenocarcinoma of the minor papilla of the duodenum treated with transduodenal minor papillectomy. A 64-year-old woman was treated for an asymptomatic duodenal tumor detected on gastroduodenoscopy. Endoscopy showed a 15-mm sessile mass in the descending duodenum proximal to the major papilla. The major papilla was a villous 24-mm-diameter polypoid tumor. Histopathologic examination of the biopsy specimen showed tubular adenoma with moderate epithelial atypia. Transduodenal major and minor papillectomies were performed. The orifice of the duct of Santorini and the pancreatic duct were re-approximated to the duodenal wall to prevent acute pancreatitis caused by scarring and stenosis of the duct orifice. Histological findings were consistent with well-differentiated adenocarcinoma limited to the minor duodenal papilla, without infiltration of the duodenal wall submucosa, and confirmed complete resection. The patient had an uneventful postoperative course and has remained asymptomatic, without evidence of tumor recurrence or stenosis of the pancreatic duct orifice, for 4 years.

Adenocarcinoma of the minor duodenal papilla treated with pancreas-sparing segmental duodenectomy: case report and review of the literature

Carcinoma of the minor duodenal papilla is extremely rare. We present the case of a 69-year-old man diagnosed with a tumor of the second portion of the duodenum by upper gastrointestinal endoscopy, which revealed a 1.5-cm elevated tumor with slight ulceration at the minor duodenal papilla. Biopsy revealed adenocarcinoma, and a computed tomography scan showed an enhanced tumor in the duodenum, with no abnormality in the pancreatic head. A pancreas-sparing segmental duodenectomy was performed, and the duodenum reconstructed with an end-to-end anastomosis. Microscopically, the tumor was a well-differentiated adenocarcinoma, with no infiltration at the cut end of the accessory pancreatic duct. The postoperative course was uneventful and the patient discharged on postoperative day 11. We reviewed previously reported cases of carcinoma of the minor duodenal papilla. Early and exact preoperative diagnosis of duodenal neoplasms makes it possible to select a less invasive treatment, which also maintains curability.

Adenocarcinoma of the minor duodenal papilla: report of a case

An 81-year-old male was found to have a duodenal tumor by screening upper gastrointestinal endoscopy. The tumor was located in the minor duodenal papilla. Pathological examination of the biopsy specimen revealed adenocarcinoma, and endoscopic ultrasound showed an elevated hypoechoic mass in the minor duodenal papilla. The preoperative diagnosis was therefore considered to be either adenocarcinoma of the minor duodenal papilla or duodenal cancer. We performed a subtotal stomach-preserving pancreaticoduodenectomy. Histopathological examination of the resected specimen showed the tumor cells to be primarily located in the submucosa of the minor duodenal papilla, with slight invasion into the pancreatic parenchyma through the accessory pancreatic duct. We therefore diagnosed a primary adenocarcima of the minor duodenal papilla. Adenocarcinoma of the minor duodenal papilla is considered to be a rare disease, but it may be underestimated because of the difficulty in distinguishing advanced adenocarcinoma of the minor duodenal papilla from primary duodenal cancer and cancer of the pancreatic head.

Adenocarcinoma of the minor duodenal papilla: report of a case

We report a case of adenocarcinoma of the minor duodenal papilla, a rare type of duodenal neoplasm. A 76-year-old man with a history of surgery for rectal cancer and gastric cancer was referred to us after a follow-up upper gastrointestinal endoscopy revealed an abnormal elevation in the minor duodenal papilla. The pathological diagnosis of a biopsy specimen was adenocarcinoma. Preoperative examination of other organs revealed a tumor in the ascending colon, which was also identified as adenocarcinoma. We performed synchronous pancreatoduodenectomy and ileocecal resection with lymph node dissection. Histopathological examination of the resected specimen revealed that the papilla tumor arose from the duodenal mucosa and infiltrated the submucosa of the duodenal wall, but not the pancreatic parenchyma. Based on these findings, we diagnosed primary adenocarcinoma of the minor duodenal papilla. To our knowledge, this is only the sixth such case reported in the English-language literature, and we review all six cases after this case report.

Synchronous adenocarcinoma of the major and minor duodenal papilla

A 50-year-old woman presented with pancreatitis, fluctuant jaundice, weight loss, and abdominal pain. Contrast-enhanced computed tomography and abdominal ultrasound showed slight dilatation of the biliary tree and gallbladder without calculi. Endoscopy demonstrated a tumor protruding from the papilla of Vater. First endoscopically biopsy diagnosed no tumor, and a second biopsy diagnosed as papillary adenocarcinoma. The patient underwent duodenopancreatectomy. The specimen was fixed in formalin (10%). The tissue was processed routinely, and paraffin sections were stained with hematoxylin-eosin and periodic acid Schiff. Gross examination showed two tumors seen as prolapsed nodules growing isolated from the minor and major duodenal papillae measuring 1.5 and 1.0 cm, respectively, both covered by duodenal mucosa and the histologic study of both lesions demonstrated a moderately differentiated tubular adenocarcinoma, which invaded duodenal wall. After surgery, she is alive 24 months without evidence of recurrence.

Primary adenocarcinoma of the minor duodenal papilla

A 70-year-old man was admitted to our institution due to aggravation of blood-sugar level control and because an abdominal CT showed dilatation of the main pancreatic duct. Upper gastrointestinal endoscopy revealed a flat elevated tumor with central ulceration in the second portion of the duodenum. Subsequent duodenoscopy for a more detailed examination showed that the tumor had originated in the minor duodenal papilla. A biopsy specimen showed moderately differentiated adenocarcinoma. Endoscopic retrograde pancreatography via the major duodenal papilla revealed a slightly dilated main pancreatic duct and obstruction of the accessory pancreatic duct. Endoscopic ultrasonography showed a hypoechoic mass in the minor duodenal papilla with retention of the muscularis propria of the duodenum. These findings suggest that the tumor existed only to a limited extent in the minor duodenal papilla, and that the tumor did not infiltrate into the pancreas. For treatment, pylorus-preserving pancreatoduodenectomy was performed, and histological findings revealed a well-differentiated adenocarcinoma that originated in the minor duodenal papilla. Primary adenocarcinoma of the minor duodenal papilla is extremely rare. Our case is the first report of primary adenocarcinoma of the minor duodenal papilla at an early stage with no infiltration into muscularis propria of the duodenum and pancreas.

Adenocarcinoma of the minor duodenal papilla with intraepithelial spread to the pancreatic duct

It is extremely rare to encounter tumors arising exclusively in the minor duodenal papilla. We report a 60-year-old male patient with a polypoid type of adenocarcinoma of the minor papilla. Preoperative examinations, including computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), suggested pancreas divisum and showed a series of stones in the dorsal pancreatic duct. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). On histology, an adenocarcinoma was located in the minor papilla, which was limited to the mucosa, without invasion of the duodenum, sphincter muscles of the minor papilla, or the underlying pancreas. The carcinoma cells, together with dysplastic and hyperplastic epithelium of the pancreatic duct, extended peripherally within the pancreatic duct. No cystic dilatation of the pancreatic duct was observed. The ventral pancreatic duct was short and narrow; there was evidence of chronic pancreatitis in the dorsal pancreas, whereas the ventral pancreas was almost normal, suggesting the existence of pancreas divisum. Although it is well known that adenocarcinoma of the duodenal papilla is sometimes accompanied by intraepithelial spread in the pancreatic duct, an adenocarcinoma arising in the minor papilla in this case with pancreas divisum was more extended than our thoughts.