Abstract
The case is a 44-year-old man, in whom a protuberant lesion was pointed out by an occasional check-up examination in the descending part of duodenum. Fiberscopic examination of the duodenum revealed a tumor with bridging fold, and the biopsy of its superficial erosion confirmed a carcinoid tumor. Endoscopic retrograde cholangiopancreatography revealed an opening of accessory pancreatic duct in the central part of the tumor, thus leading to the preoperative diagnosis as carcinoid of an accessory papilla of the duodenum. Serum serotonin level was within normal limits. Pancreatoduodenectomy was carried out. The tumor extirpated was 1.8 cm sized, but presented infiltration of the pancreas and metastases to the regional lymph nodes. Pathologically, the solid islands of tumor cells and glandular structures with central lumina were present. The lumina of the glandular structures contained psammoma bodies that are characteristic of the histologic pattern. Immunohistologically, somatostatin antibodypositive cells were noted. In any case of submucosal tumor found in the descending part of duodenum, it was thought necessary to make examination in consideration of possible carcinoid of the accessory papilla as well and also to carry out pancreatoduodenectomy for the treatment of the above carcinoid.
