Korean J Gastroenterol.  2018 Oct;72(4):217-221. 10.4166/kjg.2018.72.4.217.

Endoscopic Papillectomy for Synchronous Major and Minor Duodenal Papilla Neuroendocrine Tumors

• Seo YK
• Choi JS

• KMID: 2424115
• DOI: http://doi.org/10.4166/kjg.2018.72.4.217

Abstract

Neuroendocrine tumor (NET) of the major duodenal papilla is a rare occurrence. However, that of the minor duodenal papilla is even rarer. To date, only a few cases have been reported. Herein, we present a rare case of NETs detected at the major and minor duodenal papilla synchronously, which were successfully treated with endoscopic papillectomy without procedure-related complication. To the best of our knowledge, this is the first report of this kind in the world. Photomicrograph of the biopsy specimen stained immunohistochemically for synaptophysin showed a positive reaction of tumor cells. All resection margins were negative. Further experience with more cases will be needed to establish the exact indication of endoscopic papillectomy for duodenal papillary NETs.

Keyword

Neuroendocrine tumors; Major duodenal papilla; Minor duodenal papilla

MeSH Terms

Ampulla of Vater
Biopsy
Neuroendocrine Tumors*
Pancreatic Ducts*
Synaptophysin
Synaptophysin

Figure

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  Fig. 1. MRCP image showing clinically normal biliary tree and pancreatic duct. MRCP, magnetic resonance cholangiopancreatography.

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  Fig. 2. Side-viewing duodenoscopic findings for minor duodenal papilla. (A) Endoscopy showing an enlarged tumor at the minor duodenal papilla, with shallow ulcers and ectatic vessels at the top of the tumor. (B) Gross finding of the resected specimen after endoscopic snare minor papillectomy.

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  Fig. 3. Pathologic findings of a neuroendocrine tumor of the minor duodenal papilla. (A) On low-power view, glandular proliferation of tumor cells was seen in mucosa and submucosa. Lymphovascular and perineural invasion was not observed (H&E, ×40). (B) On high-power view, tumor cells were monomorphic and uniform-sized, showing a trabecular, rosette pattern with small round cells featuring small round nuclei and pink-to-pale cytoplasm (H&E, ×400). (C) Tumor cells showing positivity for Ki-67 (Ki-67 stain, ×200). (D) Tumor cells were reactive to synaptophysin immunohistochemistry, evidence of neuroendocrine neoplasm (synaptophysin stain, ×200).

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  Fig. 4. Side-viewing duodenoscopic findings for major duodenal papilla. (A) Endoscopy showing a rather prominent major duodenal papilla, but with preserved configuration. There were hyperemic granular changes and ectatic vessels. (B) Gross finding of the resected specimen after endoscopic snare major papillectomy.

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  Fig. 5. Pathologic findings of a neuroendocrine tumor of the major duodenal papilla. (A) On low-power view, tumor cells were limited to submucosa. Lymphovascular and perineural invasion was not seen (H&E, ×40). (B) On high-power view, tumor cells were monomorphic, uniform-sized, and showed a trabecular, rosette pattern with small round cells featuring small round nuclei and pink-to-pale cytoplasm (H&E,×400). (C) Tumor cells showing positive reaction for Ki-67 (Ki-67 stain, ×200). (D) Tumor cells were reactive to synaptophysin immunohistochemistry, evidence of neuroendocrine neoplasm (synaptophysin stain, ×100).

Reference

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