A Case of Neuroendocrine Neoplasm in the Accessory Papilla of the Duodenum

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  • Ishizaka Naoki
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Kuroiwa Yudai
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Notake Tsuyoshi
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Shimizu Akira
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Kubota Koji
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Ikehara Tomohiko
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Hayashi Akira
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Yasukawa Koya
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Kobayashi Akira
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine
  • Matsumoto Yuki
    Department of Histopathology, Shinshu University School of Medicine
  • Kobayashi Mikiko
    Department of Histopathology, Shinshu University School of Medicine
  • Soejima Yuji
    Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine

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  • 十二指腸副乳頭原発神経内分泌腫瘍の1例

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<p>A 56-year-old woman was found to have a tumor of 2 cm in size on the pancreatic side of the descending part of the duodenum on upper gastrointestinal endoscopy. Abdominal CT showed a 2-cm, well-defined nodule with a poor contrast effect, and a swollen lymph node suspected to be due to lymph node metastasis around the head of the pancreas. Endoscopic ultrasonography (EUS) showed a low echo mass with an irregular margin in the third layer. EUS-guided biopsy led to diagnosis of this region as neuroendocrine neoplasm (NEN), and pancreatico­duodenectomy was performed. Histopathological examination revealed that the tumor had grown just below the mucosa of the accessory papilla of the duodenum and surrounded the accessory pancreatic duct, leading to diagnosis of NEN derived from the accessory papilla of the duodenum. Metastasis of NEN to lymph nodes around the head of the pancreas was also diagnosed. The postoperative course was uneventful and the patient was discharged 22 days after the operation. Most duodenal NEN occurs in the bulb and descending region, whereas NEN in the accessory papilla of the duodenum is rare, with an incidence of only 2.2%. However, NEN derived from the accessory papilla has a high risk of lymph node metastasis, even if the tumor diameter is small. We report a case of resection of NEN of the accessory papilla of the duodenum.</p>

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