Abstract
A 74-year-old man was referred to our hospital for evaluation of anemia and underwent gastrointestinal endoscopy. Endoscopic examination revealed a brownish submucosal tumor measuring 20 mm in diameter in the second portion of the duodenum, which was freely mobile, with a sharp rise in the left wall at the minor papilla of the duodenum. Endoscopic ultrasonography showed a hypoechoic mass. Biopsy revealed a neuroendocrine tumor (NET) G1. Abdominal contrast-enhanced CT revealed an enhancing tumor in the descending portion of the duodenum, measuring 15 mm in diameter, and four enhancing nodular shadows with a maximum diameter of 13 mm were found on the dorsal side of the pancreatic bile duct and to the left of the uncinate process of the pancreas. A subtotal stomach-preserving pancreatoduodenectomy was performed. Histopathology with evaluation of the Ki-67 index and mitotic index confirmed the diagnosis of a NET G2, and the nodular shadows around the pancreatic head were metastatic lymph nodes. NETs arising from the minor duodenal papilla are often associated with lymph node metastases, therefore, radical surgery is usually recommended.
