Endoscopy 2007; 39: E221
DOI: 10.1055/s-2007-966565
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Colloid carcinoma of the minor duodenal papilla

H.  Varnholt1, 4 , R.  B.  Wait2 , J.  D.  Mueller1 , D.  J.  Desilets3
  • 1Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA
  • 2Department of Surgery, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA
  • 3Department of Gastroenterology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts, USA
  • 4Department of Pathology, University of Cologne, Germany
Further Information

D. J. Desilets, MD, PhD

Department of Medicine

Division of Gastroenterology

Baystate Medical Center

Tufts University School of Medicine

759 Chestnut Street

Springfield

MA 01199

USA

Fax: +1-413-794-8828

Email: david.desilets@bhs.org

Publication History

Publication Date:
05 July 2007 (online)

Table of Contents

A 43-year-old woman presented with intermittent epigastric pain and nausea. Her hemoglobin concentration was 10.3 g/dL. Abdominal imaging revealed a 4-cm cystic mass in the pancreatic head ([Figure 1]). ERCP showed an ulcerated polypoid mass at the minor duodenal papilla ([Figure 2]). Cannulation of the normal-appearing major papilla showed a dilated, 4-mm main pancreatic duct and a stricture of the main duct in the head of the gland ([Figure 3]). Cannulation through the mass showed contrast in the ectatic dorsal pancreatic duct, which confirmed involvement of the minor papilla by tumor. Pancreas divisum was not present. A pancreaticoduodenectomy (Whipple procedure) revealed a polypoid gelatinous mass measuring 3 × 2 × 1.5 cm protruding from the minor papilla. Histologically the tumor showed mucin pools containing malignant epithelial cells ([Figure 4]). Resection margins and 15 peripancreatic lymph nodes were free of tumor. Despite an uncomplicated immediate postoperative course, CA 19 - 9 levels are rising 22 months later along with possible liver metastases.

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Figure 1 Computed tomography showing cystic mass in the head of the pancreas.

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Figure 2 Ulcerated, polypoid mass at the minor duodenal papilla.

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Figure 3 Stricture of the proximal duct of Wirsung seen at ERCP.

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Figure 4 Histological appearance of the tumor with pools of mucin containing scant malignant glandular epithelial cells. (H&E; original magnification × 20).

Tumors of the minor papilla are uncommon, but carcinoid tumors [1], somatostatinomas [2], and a case of a nonendocrine ductal adenocarcinoma [3] have been reported. Reasons for the rarity of recorded tumors in this location may be a low incidence but also the lack of symptoms caused by small indolent endocrine neoplasms and the absence of jaundice owing to patency of the major papilla [3]. Aggressive neoplasms may overgrow adjacent structures, thus obscuring their origin at the minor papilla [3]. Mucinous noncystic (colloid) carcinoma of the pancreas represents only 1 % - 2 % of all pancreatic nonendocrine neoplasms [4] [5] and has not been described in the minor papilla previously. It is characterized histologically by extracellular mucin lakes with “floating” malignant epithelial cells [4] [5]. It is important to distinguish colloid carcinoma from mucin-producing adenocarcinoma, signet-ring cell carcinoma and mucinous cystic neoplasms because the prognosis of colloid carcinoma is significantly better than that of ordinary pancreatic ductal adenocarcinoma, with a 5-year survival rate of 57 % [4] [5].

Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AB

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References

D. J. Desilets, MD, PhD

Department of Medicine

Division of Gastroenterology

Baystate Medical Center

Tufts University School of Medicine

759 Chestnut Street

Springfield

MA 01199

USA

Fax: +1-413-794-8828

Email: david.desilets@bhs.org

#

References

D. J. Desilets, MD, PhD

Department of Medicine

Division of Gastroenterology

Baystate Medical Center

Tufts University School of Medicine

759 Chestnut Street

Springfield

MA 01199

USA

Fax: +1-413-794-8828

Email: david.desilets@bhs.org

Zoom Image

Figure 1 Computed tomography showing cystic mass in the head of the pancreas.

Zoom Image

Figure 2 Ulcerated, polypoid mass at the minor duodenal papilla.

Zoom Image

Figure 3 Stricture of the proximal duct of Wirsung seen at ERCP.

Zoom Image

Figure 4 Histological appearance of the tumor with pools of mucin containing scant malignant glandular epithelial cells. (H&E; original magnification × 20).