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Sato T, Sagami R, Nishikiori H, Tsuji H, Sato K, Daa T, Murakami K. Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy. Intern Med 2021; 60:2593-2599. [PMID: 33716282 PMCID: PMC8429288 DOI: 10.2169/internalmedicine.6404-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | - Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | | | - Hiroaki Tsuji
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | - Keiji Sato
- Department of Clinical Laboratory, Oita San-ai Medical Center, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
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Melo CM, Origassa CST, Theodoro TR, Matos LL, Miranda TA, Accardo CM, Bouças RI, Suarez ER, Pares MMNS, Waisberg DR, Toloi GC, Nader HB, Waisberg J, Pinhal MAS. Analysis of heparanase isoforms and cathepsin B in the plasma of patients with gastrointestinal carcinomas: analytical cross-sectional study. SAO PAULO MED J 2015; 133:28-35. [PMID: 25351637 PMCID: PMC10496619 DOI: 10.1590/1516-3180.2013.7080003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 04/29/2013] [Accepted: 01/29/2014] [Indexed: 01/23/2023] Open
Abstract
CONTEXT AND OBJECTIVE Heparanase-1 degrades heparan sulfate and has been correlated with tumor progression. Although the isoform heparanase-2 has no catalytic activity, it seems to be important for modulating heparanase-1 activity. Cathepsin B is a proteinase involved in tumor metastasis. The aim of this study was to analyze heparanase isoform expression and cathepsin B activity in plasma samples from patients with gastrointestinal carcinomas, compared with healthy individuals (control group). DESIGN AND SETTING This was an analytical cross-sectional study. Peripheral blood samples were collected at a Brazilian public hospital, from 21 patients with histopathological diagnoses of gastrointestinal carcinomas and from 43 healthy individuals. The analyses were performed in two Brazilian medical schools. METHODS Heparanase isoforms were identified and quantified in plasma samples by means of Western blot. The enzymatic activities of heparanase-1 and cathepsin B were also measured. RESULTS The results demonstrated that the expression of both heparanase isoforms was significantly greater in plasma samples from gastrointestinal carcinoma patients, compared with the control group. Logistic regression analysis showed that increased heparanase-1 and heparanase-2 expression was exclusively dependent on the tumor. There was a significant increase in heparanase-1 and cathepsin B activity in the patients' plasma. CONCLUSION Overexpression of heparanase-1 and heparanase-2, along with increased heparanase-1 and cathepsin B activity in plasma, is associated with the diagnosis of gastrointestinal carcinoma. These findings provide support for using non-invasive assays (plasma samples) as an auxiliary method for diagnosing gastrointestinal tumors.
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Affiliation(s)
- Carina Mucciolo Melo
- MSc. Doctoral Student, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | | | | | - Leandro Luongo Matos
- MD, PhD. Associate Professor, Department of Biochemistry, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil.
| | - Thaís Aguilar Miranda
- MSc. Research Collaborator, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Camila Melo Accardo
- PhD. Postdoctoral Student, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Rodrigo Ippolito Bouças
- PhD. Research Collaborator, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Eloah Rabello Suarez
- PhD. Postdoctoral Student, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | | | - Daniel Reis Waisberg
- MD. Attending Physician. Surgery Department, Universidade de São Paulo (USP), São Paulo, Brazil.
| | - Giovanna Canato Toloi
- Medical Student. Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil.
| | - Helena Bonciani Nader
- PhD. Titular Professor, Department of Biochemistry, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Jaques Waisberg
- MD, PhD. Adjunct Professor, Department of Surgery, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil.
| | - Maria Aparecida Silva Pinhal
- PhD. Titular Professor, Department of Biochemistry, Faculdade de Medicina do ABC (FMABC), Santo André, São Paulo, Brazil.
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Suzumura K, Hai S, Kuroda N, Hirano T, Asano Y, Okada T, Iimuro Y, Tanaka S, Nakasho K, Fujimoto J. Primary adenocarcinoma of the minor duodenal papilla with mass-forming chronic pancreatitis: report of a case. Surg Today 2015; 45:506-10. [PMID: 24522893 DOI: 10.1007/s00595-014-0860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
Abstract
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.
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Hoshino A, Nakamura Y, Suzuki H, Mizutani S, Ishii H, Watanabe M, Bou H, Yoshino M, Komine O, Uchida E. Adenocarcinoma of the minor duodenal papilla: report of a case. J NIPPON MED SCH 2013; 80:165-70. [PMID: 23657071 DOI: 10.1272/jnms.80.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Arichika Hoshino
- Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
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Zuiki T, Sata N, Sasanuma H, Koizumi M, Shimura K, Sakuma Y, Hyodo M, Lefor AT, Yasuda Y. Adenocarcinoma of the minor duodenal papilla treated with pancreas-sparing segmental duodenectomy: case report and review of the literature. Clin J Gastroenterol 2011; 4:412-7. [PMID: 26189746 DOI: 10.1007/s12328-011-0262-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 09/05/2011] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Toru Zuiki
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Hideki Sasanuma
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Masaru Koizumi
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Kunihiko Shimura
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yasunaru Sakuma
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Masanobu Hyodo
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Alan T Lefor
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yoshikazu Yasuda
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
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Abstract
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.
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Affiliation(s)
- Kazuhiro Takami
- Department of Surgery, Obihiro Daiichi Hospital, Obihiro, Japan
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Okuma T, Ozaki T, Abe S, Yamamura K, Shigaki H, Sawayama H, Tanaka H, Mizumoto T, Yamaguchi Y, Matsumoto T, Tomiyasu S, Hongoh H, Kamio T, Mita S, Kanemitsu K. Adenocarcinoma of the minor duodenal papilla: report of a case. Surg Today 2011; 41:568-71. [PMID: 21431496 DOI: 10.1007/s00595-010-4314-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 01/06/2010] [Indexed: 10/18/2022]
Abstract
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.
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