Histomorphological study on the minor duodenal papilla

Ohta, Testuo; Nagakawa, Takukazu; Kobayashi, Hironobu; Kayahara, Masato; Ueno, Koichi; Konishi, Ichirou; Miyazaki, Itsuo

doi:10.1007/bf02781925

Cited by 21 publications

(11 citation statements)

References 6 publications

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“…14,15 This region contains the accessory (Santorini) pancreatic duct, tissue of the dorsal pancreas (which penetrates the muscularis propria of the duodenum), and surrounding fi brotic connective tissue. 11,16 This anatomical complexity and the lack of characteristic symptoms make diagnosing tumors of the minor duodenal papilla diffi cult. Thus, when these tumors arise they are not detected until an advanced stage of disease, 11 when the origin is diffi cult to determine.…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the minor duodenal papilla: Report of a case

Okuma¹,

Ozaki

Abe

et al. 2011

Surg Today

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We report a case of adenocarcinoma of the minor duodenal papilla, a rare type of duodenal neoplasm. A 76-year-old man with a history of surgery for rectal cancer and gastric cancer was referred to us after a follow-up upper gastrointestinal endoscopy revealed an abnormal elevation in the minor duodenal papilla. The pathological diagnosis of a biopsy specimen was adenocarcinoma. Preoperative examination of other organs revealed a tumor in the ascending colon, which was also identified as adenocarcinoma. We performed synchronous pancreatoduodenectomy and ileocecal resection with lymph node dissection. Histopathological examination of the resected specimen revealed that the papilla tumor arose from the duodenal mucosa and infiltrated the submucosa of the duodenal wall, but not the pancreatic parenchyma. Based on these findings, we diagnosed primary adenocarcinoma of the minor duodenal papilla. To our knowledge, this is only the sixth such case reported in the English-language literature, and we review all six cases after this case report.

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Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the minor duodenal papilla: Report of a case

Okuma¹,

Ozaki

Abe

et al. 2011

Surg Today

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“…The minor duodenal papilla is situated in the anterior duodenal wall, about 2 cm proximal to the major papilla [2,16]. It primarily drains pancreatic fluid from the dorsal pancreas to the duodenum in the embryo [7].…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma of the minor duodenal papilla with intraepithelial spread to the pancreatic duct

et al. 2007

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It is extremely rare to encounter tumors arising exclusively in the minor duodenal papilla. We report a 60-year-old male patient with a polypoid type of adenocarcinoma of the minor papilla. Preoperative examinations, including computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP), suggested pancreas divisum and showed a series of stones in the dorsal pancreatic duct. The patient underwent subtotal stomach-preserving pancreaticoduodenectomy (SSpPD). On histology, an adenocarcinoma was located in the minor papilla, which was limited to the mucosa, without invasion of the duodenum, sphincter muscles of the minor papilla, or the underlying pancreas. The carcinoma cells, together with dysplastic and hyperplastic epithelium of the pancreatic duct, extended peripherally within the pancreatic duct. No cystic dilatation of the pancreatic duct was observed. The ventral pancreatic duct was short and narrow; there was evidence of chronic pancreatitis in the dorsal pancreas, whereas the ventral pancreas was almost normal, suggesting the existence of pancreas divisum. Although it is well known that adenocarcinoma of the duodenal papilla is sometimes accompanied by intraepithelial spread in the pancreatic duct, an adenocarcinoma arising in the minor papilla in this case with pancreas divisum was more extended than our thoughts.

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“…Islets in pancreatic tissue of the MIP are round to ovoid in shape, sharply outlined, and contain abundant B cells and few PP cells immunohistochemically. 41 A minute focus of endocrine cells was observed in the area surrounding the APD. 42 Several types of endocrine tumors of the MIP have been reported, including carcinoids, 42 somatostatinoma, 43 adenoma, 44 and adenocarcinoma.…”

Section: Fig 2 Amentioning

confidence: 98%

Clinical significance of the minor duodenal papilla and accessory pancreatic duct

Kamisawa

2004

J Gastroenterol

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The accessory pancreatic duct (APD) is the main drainage duct of the dorsal pancreatic bud in the embryo, entering the duodenum at the minor duodenal papilla (MIP). As development progresses, the duct of the dorsal bud undergoes varying degrees of atrophy at the duodenal end. In cases of patent APD, smooth-muscle fiber bundles derived from the duodenal proper muscular tunics surround the APD. The APD shows long and short patterns on pancreatography, and ductal fusion in the two types appears to differ embryologically. Patency of the APD in control cases, as determined by dye-injection endoscopic retrograde pancreatography, was 43%. Patency of the APD may depend on duct caliber, course, and terminal shape of the APD. A patent APD may prevent acute pancreatitis by reducing the pressure in the main pancreatic duct. Pancreas divisum is a common anatomical anomaly in which the ventral and dorsal pancreatic ducts do not unite embryologically. As the majority of exocrine flow is routed through the MIP in individuals with pancreas divisum, interrelationships between poor function of the MIP and increased flow of pancreatic juice caused by alcohol or diet may increase dorsal pancreatic duct pressure and lead to the development of pancreatitis. Wire-guided minor sphincterotomy, followed by dorsal duct stenting, is recommended for acute recurrent pancreatitis associated with pancreas divisum.

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Histomorphological study on the minor duodenal papilla

Cited by 21 publications

References 6 publications

Adenocarcinoma of the minor duodenal papilla: Report of a case

Adenocarcinoma of the minor duodenal papilla: Report of a case

Adenocarcinoma of the minor duodenal papilla with intraepithelial spread to the pancreatic duct

Clinical significance of the minor duodenal papilla and accessory pancreatic duct

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