Abstract
We reported herein an extremely rare case of adenocarcinoma arising from the minor duodenal papilla in association with unique pancreatic duct dilatation. The patient was 74 year-old woman, in whom the increased level of the serum CA19-9 (274mg/ml) was pointed out by the medical check-up for anemia. The upper and lower gastrointestinal endoscopy and the CT did not demonstrate any abdominal lesion, but the serum CA19-9 level had been increasing with time. Seven months after the first endoscopy, the lesion, which showed FDG accumulation, was detected around the 2nd portion of the duodenum by PET. Therefore, upper gastrointestinal endoscopy was performed again, and the type 2 tumor of the duodenum was found. In CT and MR, the prominent dilatation of the pancreatic duct confined to the lower portion of the pancreatic head was disclosed. It took 9 months from the first medical examination to pancreaticoduodenectomy. The tumor was 32mm in diameter and the opening of the accessory pancreatic duct was located in the center of the tumor. Microscopically, the intraepithelial spread of cancer was observed in the accessory pancreatic duct. In this report, we can point out that the minor papilla is easily overlooked by routine endoscopic observation.
