title: Primary adenocarcinoma of the minor duodenal papilla.
abstract: 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.
authors.affiliation: Department of Internal Medicine 2, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Wakatsuki
authors.forename: Atsushi
authors.initials: A
authors.lastname: Irisawa
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Takagi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Koyama
authors.forename: Sayuri
authors.initials: S
authors.lastname: Hoshi
authors.forename: Seiichi
authors.initials: S
authors.lastname: Takenoshita
authors.forename: Masafumi
authors.initials: M
authors.lastname: Abe
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ohira
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D019160:Endosonography; D006801:Humans; D008297:Male; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000648:ultrastructure