Korean J Gastroenterol.  2011 Sep;58(3):144-148. 10.4166/kjg.2011.58.3.144.

A Case of a Neuroendocrine Carcinoma in the Minor Papilla

• Ha DW
• Kim GH
• Kim DU
• Bae MJ
• Kim BW
• Jeon HK
• Park DY
• Seo HI

• KMID: 1018402
• DOI: http://doi.org/10.4166/kjg.2011.58.3.144

Abstract

Neuroendocrine tumors are usually found in the ileum, appendix, rectum, colon and stomach. Ampullary neuroendocrine tumor is extremely rare and only a few cases of neuroendocrine carcinoma of the minor papilla have been reported. The preoperative diagnosis is very challenging because either asymptomatic or manifests as nonspecific abdominal pain. The tumor is relatively small and located at the deep mucosa and submucosa. Endoscopy with deep biopsy, endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography are good diagnostic tools. The best therapeutic choice is surgery. We report an unusual case of a 55-year-old woman who underwent endoscopy as part of a regular health checkup and was diagnosed a neuroendocrine carcinoma in the minor papilla, which was successfully resected by pancreaticoduodenectomy.

Keyword

Neuroendocrine carcinoma; Minor duodenal papilla

MeSH Terms

Carcinoma, Neuroendocrine/*diagnosis/pathology/ultrasonography
Duodenal Neoplasms/*diagnosis/pathology/ultrasonography
Duodenoscopy
Female
Humans
Middle Aged
Neoplasm Staging
Pancreaticoduodenectomy
Tomography, X-Ray Computed

Figure

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  Fig. 1. (A) Duodenoscopic findings. A submucosal tumor was seen on the minor papilla. (B) Endosonographic findings. The tumor was about 1.6 cm sized and located in the deep mucosal and submucosal layers.

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  Fig. 2. Abdominal CT findings. (A) Axial image. (B) Coronal reformat image. An about 1.5 cm sized highly enhancing round mass was seen on periampullary region.

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  Fig. 3. Gross findings of surgical resected specimen. (A) A polypoid mass was seen around the minor papilla. (B) Cross-section of the resected specimen after 24 hours formalin fixation.

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  Fig. 4. Pathologic findings. (A) At the low power view, tumor cells made gland-like lumina but did not make true gland. Tumor cells occasionally contain secretions and psammomatous calcification (H&E stain, ×100). (B) At the high power view, tumor cells were monomorphic, uniform-sized and showed a travecular and rosette pattern (H&E stain, ×200). (C) Lymphatic tumor emboli (arrow) was present at peritumoral area of submucosal layer (H&E stain, ×100). (D) Tumor cells were reactive to synaptophysin immunohistochemistry, which was an evidence of neuroendocrine neoplasm (synaptophysin stain, ×200).

Reference

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