A Case of Primary Adenocarcinoma of the Minor Duodenal Papilla

Abstract

A 79-year-old woman underwent upper gastrointestinal endoscopy to investigate chronic anemia, and an elevated lesion with an irregular surface and redness was detected at the site where the minor duodenal papilla should have been. The pathological diagnosis of the biopsy specimen was suspected adenocarcinoma. This tumor was not detected by computed tomography (CT), but positron emission tomography (PET) showed faint accumulation of FDG in the duodenum. Since there were no other metastatic lesions, subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) was performed. After surgery, a nasogastric tube was placed for over a month because of delayed gastric emptying, which then improved gradually, and she was discharged on postoperative day 54. Pathological findings of this resected specimen showed poorly differentiated adenocarcinoma with infiltration into pancreatic parenchyma. There were no findings of lymph node metastasis. No recurrence or metastasis has been detected for about 70 months after surgery. Most tumors of the minor duodenal papilla have been previously reported to be adenomas, neuroendocrine tumors, or, rarely, gangliocytic paragangliomas. Adenocarcinoma is extremely rare. A rare case of primary adenocarcinoma of the minor duodenal papilla is described.