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Neuroendocrine tumor of the minor duodenal papilla with lymph node metastasis: a case report and literature review

  • Case Report - Pathology
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Abstract

Whether pancreatoduodenectomy or papillary resection should be performed to achieve curative treatment for neuroendocrine tumors of the minor duodenal papilla with a diameter of ≤2 cm is controversial. We report a 35-year-old male patient with a rare case of a neuroendocrine tumor of the minor duodenal papilla. The patient was referred to our hospital from a different clinic for dilatation of his minor duodenal papilla. Duodenoscopy revealed a smooth mass of 2 cm in diameter in the minor papilla, and the biopsy specimen was diagnosed as neuroendocrine tumor G1. The patient underwent subtotal stomach-preserving pancreatoduodenectomy. Histological evaluation showed a single nodule of 15 mm in diameter in the mucosa with metastasis to the regional lymph node. The tumor cells exhibited immunoactivity against synaptophysin and chromogranin A. The molecular immunology Borstel-1 index was less than 1%, and the grade was neuroendocrine tumor G1. We reviewed the characteristics of 24 cases of patients who underwent PD for NETs of the minor duodenal papilla in English literature. In 22 of these cases, the tumor depth was described. Lymph node metastasis was observed in none of the three cases (0%) in which the tumor was limited to the intra-sphincter; however, it was noted in three (30%) of the 10 cases in which the tumor had invaded the duodenal submucosa and in eight (89%) of the nine cases in which the tumor had invaded the muscularis propria, pancreas, peripancreatic/periduodenal tissues, or duodenal serosa. Making a definitive diagnosis preoperatively or intraoperatively whether the tumor invades beyond the sphincter or not and whether regional lymph node metastasis is present may not be possible. Therefore, we believe that pancreatoduodenectomy with lymphadenectomy is preferable for curative treatment of neuroendocrine tumors of the minor duodenal papilla.

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All data generated or analyzed during this case report are included in this published article.

Abbreviations

NET:

Neuroendocrine tumor

PD:

Pancreatoduodenectomy

SSPPD:

Subtotal stomach-preserving pancreatoduodenectomy

NBI:

Narrow band imaging

EUS:

Endoscopic ultrasonography

CT:

Computed tomography

MRCP:

Magnetic resonance cholangiopancreatography

ACTH:

Adrenocorticotropic hormone

DHEA-S:

Dehydroepiandrosterone sulfate

18F-FDG:

18F-fluorodeoxyglucose

PET:

Positron emission tomography

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Acknowledgements

This manuscript was proofread by a professional editor who is a native speaker of English at Editage, a division of Cactus Communications (https://www.editage.jp).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan

    Hideo Ota, Shigekazu Yokoyama & Mutsumi Fukunaga

  2. Department of Gastroenterological Surgery, Nippon Life Hospital, 2-1-54 Enokojima, Nishi-ku, Osaka, Osaka, 550-0006, Japan

    Hideo Ota

  3. Department of Gastroenterology, Hyogo Prefectural Nishinomiya Hospital, 13-9, Rokutanji-cho, Nishinomiya, Hyogo, 662-0918, Japan

    Kazunori Yanagawa & Sadaharu Iio

Authors
  1. Hideo Ota
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  2. Shigekazu Yokoyama
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  3. Kazunori Yanagawa
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  4. Sadaharu Iio
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  5. Mutsumi Fukunaga
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Contributions

HO, SY, and KY: conceived and designed the study. HO, SY, KY, SI, and MF: acquired the data. HO, SY, and KY: drafted the manuscript. All authors have read and approved the final manuscript.

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Correspondence to Hideo Ota.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval and consent to participate

This clinical research was approved by the Research Ethics Board of the Hyogo Prefectural Nishinomiya Hospital and conducted according to Institutional Review Board guidelines. Written informed consent was obtained from the patient prior to the publication of the present case report.

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Written informed consent was obtained from the patient involved in this publication and accompanying images. A copy of this written consent is available for review by the Editor-in-Chief of this journal.

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Ota, H., Yokoyama, S., Yanagawa, K. et al. Neuroendocrine tumor of the minor duodenal papilla with lymph node metastasis: a case report and literature review. Int Canc Conf J 12, 255–262 (2023). https://doi.org/10.1007/s13691-023-00624-8

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  • DOI: https://doi.org/10.1007/s13691-023-00624-8

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