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Khalyfa AA, Ahsan N, Inam M, Ayub K. Endoscopic management of tumors of minor ampulla: a multicenter study. Endosc Int Open 2022; 10:E978-E981. [PMID: 35845025 PMCID: PMC9286768 DOI: 10.1055/a-1839-5401] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background and study aims Papillary and duodenal carcinoma are aggressive cancers with poor 5-year survival rates. Papillectomy is a well-established treatment for early-stage carcinoma of the major papilla. Tumors arising in the minor papilla are relatively rare and there is little research available on the endoscopic management of these tumors. Patients and methods The purpose of this study was to establish the safety and efficacy of endoscopic papillectomy in the management of minor papillary tumors. A total of six patients undergoing ERCP for papillectomy for minor papillary tumor at four hospitals were included in this study over a period of 5 years. Results Papillectomy was technically successful in all six patients. Pathology revealed adenoma in three patients, adenoma with high-grade dysplasia in one patient, carcinoma in one patient, and carcinoid tumor in one patient. For follow-up, one patient had an additional tumor identified at 2 years which was found to be a recurrence of the original adenoma. This patient was treated with repeat papillectomy with no further evidence of recurrence. Conclusions In our pilot study, we demonstrate that endoscopic papillectomy appears safe and effective in the management of minor papillary tumors.
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Affiliation(s)
- Ahamed A. Khalyfa
- Franciscan Saint James Health Olympia Fields Campus, Gastroenterology
| | - Nayab Ahsan
- Southwest Gastroenterology, Gastroenterology
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2
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Sato T, Sagami R, Nishikiori H, Tsuji H, Sato K, Daa T, Murakami K. Endoscopic Mucosal Resection of Adenocarcinoma at the Minor Duodenal Papilla: A Case Report and Suggestions for the Optimal Treatment Strategy. Intern Med 2021; 60:2593-2599. [PMID: 33716282 PMCID: PMC8429288 DOI: 10.2169/internalmedicine.6404-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We herein report an extremely rare case of adenocarcinoma of the minor duodenal papilla (MiDP) which was successfully treated by endoscopic mucosal resection (EMR). An asymptomatic 84-year-old man underwent upper gastrointestinal endoscopy, which revealed a slightly elevated lesion at the MiDP. The biopsy findings were suggestive of adenocarcinoma. Computed tomography, magnetic resonance images and endoscopic ultrasonography did not reveal pancreatic tumor infiltration nor any apparent distant metastases. Therefore, we treated the lesion using EMR with complete resection. No recurrence or metastasis has been detected at 13 months after EMR. Total resection of the MiDP can thus serve as a relatively safe and simple treatment.
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Affiliation(s)
- Takao Sato
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | - Ryota Sagami
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | | | - Hiroaki Tsuji
- Department of Gastroenterology, Oita San-ai Medical Center, Japan
| | - Keiji Sato
- Department of Clinical Laboratory, Oita San-ai Medical Center, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Japan
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3
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Kilcoyne M, Gauvin G, Cooley J, Nagarathinam R, Lefton M, Kutikov A, Reddy S. Extraluminal Duodenal Gangliocytic Paraganglioma Presenting with Intractable Back Pain in a Patient with End-Stage Renal Disease. J Gastrointest Cancer 2021; 51:677-680. [PMID: 31940134 DOI: 10.1007/s12029-020-00357-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Maxwell Kilcoyne
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Gabrielle Gauvin
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Jennifer Cooley
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | | | - Max Lefton
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Alexander Kutikov
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Sanjay Reddy
- Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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4
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Vanoli A, Albarello L, Uncini S, Fassan M, Grillo F, Di Sabatino A, Martino M, Pasquali C, Milanetto AC, Falconi M, Partelli S, Doglioni C, Schiavo-Lena M, Brambilla T, Pietrabissa A, Sessa F, Capella C, Rindi G, La Rosa S, Solcia E, Paulli M. Neuroendocrine Tumors (NETs) of the Minor Papilla/Ampulla: Analysis of 16 Cases Underlines Homology With Major Ampulla NETs and Differences From Extra-Ampullary Duodenal NETs. Am J Surg Pathol 2019; 43:725-736. [PMID: 30913089 DOI: 10.1097/pas.0000000000001234] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Neuroendocrine tumors (NETs) of the minor papilla/ampulla (MIPA) are rare and poorly studied. Only individual case reports and no comprehensive analysis are available from the literature. We collected 16 MIPA NETs and investigated their clinicopathologic and immunohistochemical features, including markers such as somatostatin, pancreatic polypeptide, gastrin, serotonin, MUC1, cytokeratin 7, and somatostatin receptors type 2A and 5. The median age at diagnosis was 57.5 years, and the female-to-male ratio was 2.2:1. The median NET size was 1.45 cm, and most (94%) were low-grade (G1) tumors. Similarly to what was observed in the major ampulla, 3 histotypes were found: (i) ampullary-type somatostatin-producing tumors (ASTs, 10 cases), characterized by somatostatin expression in most tumor cells, focal-to-extensive tubulo-acinar structures, often with psammoma bodies, MUC1 reactivity, and no or rare membranous reactivity for somatostatin receptor type 2A; (ii) gangliocytic paragangliomas (3 cases), characterized by the coexistence of 3 tumor cell types: epithelioid, often reactive for pancreatic polypeptide, ganglion-like cells, and S100 reactive sustentacular/stromal cells; and (iii) ordinary nonfunctioning NETs (3 cases), resembling those more commonly observed in the extra-ampullary duodenum. Comparable histotypes could also be recognized among the 30 MIPA NETs from the literature. No NET-related patient death among MIPA cases was observed during a median follow-up of 38 months; however, MIPA ASTs showed lymph node metastases and invasion of the duodenal muscularis propria or beyond in 44% and 40% of cases, respectively. In conclusion, MIPA NETs closely resemble tumors arising in the major ampulla, with predominance of ASTs.
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Affiliation(s)
- Alessandro Vanoli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia
- Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia
| | | | - Stefania Uncini
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia
| | - Matteo Fassan
- Department of Medicine (DIMED), Surgical Pathology & Cytopathology Unit
| | - Federica Grillo
- Department of Surgical Science and Integrated Diagnostics (DISC), Pathology Unit, University of Genoa
- San Martino Hospital, Genoa
| | - Antonio Di Sabatino
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia
| | - Michele Martino
- First Department of Internal Medicine, IRCCS San Matteo Hospital Foundation, University of Pavia
| | - Claudio Pasquali
- Department of Surgery 1 Pancreatic and Endocrine Digestive Surgical Unit, University of Padua, Padua
| | - Anna C Milanetto
- Department of Surgery 1 Pancreatic and Endocrine Digestive Surgical Unit, University of Padua, Padua
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University
| | - Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, "Vita-Salute" University
| | | | | | - Tatiana Brambilla
- Pathology Unit, Humanitas Research Hospital, Humanitas University, Rozzano, Milan
| | - Andrea Pietrabissa
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Unit of General Surgery 2, University of Pavia and IRCCS San Matteo Hospital Foundation, Pavia
| | - Fausto Sessa
- Department of Medicine and Surgery, Anatomic Pathology Unit, University of Insubria, Varese
| | - Carlo Capella
- Department of Medicine and Surgery, Anatomic Pathology Unit, University of Insubria, Varese
| | - Guido Rindi
- Institute of Anatomic Pathology
- Rome ENETS Center of Excellence, University Hospital Foundation A. Gemelli IRCCS-Catholic University of Sacred Heart, Rome, Italy
| | - Stefano La Rosa
- Service of Clinical Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enrico Solcia
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia
| | - Marco Paulli
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia
- Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Pavia
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5
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Ko JK, Park DH, Hwang HS. A Case of Concurrent Ampullary Adenoma and Gangliocytic Paraganglioma at the Minor Papilla Treated with Endoscopic Resection. Clin Endosc 2019; 52:382-386. [PMID: 30974934 PMCID: PMC6680003 DOI: 10.5946/ce.2018.198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/03/2019] [Indexed: 01/09/2023] Open
Abstract
A gangliocytic paraganglioma is a benign tumor of the digestive system with a very low incidence. The tumor is histopathologically characterized by a triphasic pattern consisting of epithelioid, ganglion, and spindle-shaped Schwann cells. In most cases, it occurs in the second portion of the duodenum near the ampulla of Vater. We report a case of a gangliocytic paraganglioma occurring at the minor duodenal papilla (a rare location) with a concurrent adenoma of the ampulla of Vater. Both lesions were treated simultaneously using endoscopic resection. Additionally, we have presented a literature review.
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Affiliation(s)
- Jun Kwon Ko
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hyun Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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6
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Matsubayashi H, Ishiwatari H, Matsui T, Fujie S, Uesaka K, Sugiura T, Okamura Y, Yamamoto Y, Ashida R, Ito T, Sasaki K, Ono H. Gangliocytic Paraganglioma of the Minor Papilla of the Duodenum. Intern Med 2017; 56:1029-1035. [PMID: 28458307 PMCID: PMC5478562 DOI: 10.2169/internalmedicine.56.7812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A duodenal polyp was found during a health check of a 71-year-old asymptomatic man. Duodenoscopy demonstrated a pedunculated, smooth-surfaced tumor of 18 mm in size, protruding from the minor papilla. Endoscopic ultrasonography demonstrated a homogeneously low-echoic submucosal tumor. Enhanced computed tomography and magnetic resonance imaging demonstrated a well-enhanced duodenal tumor without obvious metastasis. A tumor biopsy revealed a well-differentiated neuroendocrine tumor, and laparotomic transduodenal polypectomy with regional lymph node dissection was performed. The histology of the surgical specimen revealed gangliocytic paraganglioma consisting of three cell types: endocrine, ganglion, and spindle cells. There has been no recurrence in >5 years after surgery.
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Affiliation(s)
| | | | - Toru Matsui
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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7
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Yang JI, Choi JS, Lee GH, Kim BW, Moon SJ, Kang MS, Ahn HJ. A case of ampullary gangliocytic paraganglioma. Korean J Intern Med 2014; 29:375-8. [PMID: 24851073 PMCID: PMC4028528 DOI: 10.3904/kjim.2014.29.3.375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 11/11/2013] [Accepted: 01/24/2014] [Indexed: 12/22/2022] Open
Abstract
Gangliocytic paragangliomas (GPs) are rare tumors of the duodenum, presenting as single sessile or pedunculated polypoid masses. Clinical manifestations of duodenal GPs can vary from an incidental finding at endoscopy to frequent upper gastrointestinal bleeding caused by mucosal ulceration and abdominal pain. GPs are considered benign, but the disease can recur and spread to regional lymph nodes. A 41-year-old female presented with abdominal pain. Upper gastrointestinal endoscopy revealed a subepithelial tumor of the ampulla of Vater in the second portion of the duodenum. The tumor was resected using the endoscopic mucosal resection technique. The tumor was diagnosed as benign GP of the duodenum using histological and immunohistochemical staining procedures.
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Affiliation(s)
- Ju-Il Yang
- Division of Gastroenterology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Jung-Sik Choi
- Division of Gastroenterology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Ga-Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Byeong-Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Seok-Jun Moon
- Division of Gastroenterology, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Mi Seon Kang
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyo Jung Ahn
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Korea
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8
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Minor Papilla Adenoma Management in Patients with Pancreas Divisum and Familial Adenomatous Polyposis. ACG Case Rep J 2013; 1:47-50. [PMID: 26157819 PMCID: PMC4435256 DOI: 10.14309/crj.2013.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/23/2013] [Indexed: 12/18/2022] Open
Abstract
Several case reports on endoscopic resection of minor papilla adenomas exist in the literature. However, there are no reported cases of endoscopic resection in patients with minor papilla adenomas with associated familial adenomatous polyposis (FAP) and pancreas divisum. We report a case of a minor papilla adenoma in a patient with FAP and pancreas divisum. The case demonstrates a new association between these disease processes. Defining pancreatic ductal anatomy prior to endoscopic intervention is essential. In addition, we demonstrate the safety and feasibility of endoscopic management of minor papilla tumors in patients with FAP and associated pancreas divisum.
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9
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Duodenal gangliocytic paraganglioma with lymph node metastasis and an 8-year follow-up: a case report. Eur J Gastroenterol Hepatol 2012; 24:90-4. [PMID: 22081010 DOI: 10.1097/meg.0b013e32834dfdfa] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Gangliocytic paraganglioma (GP) is a rare tumor, usually located in the second part of the duodenum. On pathological examination, GP is characterized by the association of the histological features of paragangliomas, ganglioneuromas, and carcinoid tumors. Classical clinical presentations are upper gastrointestinal bleeding and abdominal pain. Preoperative diagnosis is difficult because of the submucosal site of the tumor, with usually negative mucosal biopsies. Endoscopic ultrasound helps establish the diagnosis and allows lymph node staging, which will guide the choice of the treatment. If GPs usually follow a benign course, metastatic spread to regional lymph nodes treated by surgical resection alone has been reported. We report a case of GP with lymph node metastases treated by duodenopancreatectomy with long-term disease-free survival, suggesting that surgical resection is a reasonable approach for metastatic GPs.
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Zuiki T, Sata N, Sasanuma H, Koizumi M, Shimura K, Sakuma Y, Hyodo M, Lefor AT, Yasuda Y. Adenocarcinoma of the minor duodenal papilla treated with pancreas-sparing segmental duodenectomy: case report and review of the literature. Clin J Gastroenterol 2011; 4:412-7. [PMID: 26189746 DOI: 10.1007/s12328-011-0262-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 09/05/2011] [Indexed: 11/30/2022]
Abstract
Carcinoma of the minor duodenal papilla is extremely rare. We present the case of a 69-year-old man diagnosed with a tumor of the second portion of the duodenum by upper gastrointestinal endoscopy, which revealed a 1.5-cm elevated tumor with slight ulceration at the minor duodenal papilla. Biopsy revealed adenocarcinoma, and a computed tomography scan showed an enhanced tumor in the duodenum, with no abnormality in the pancreatic head. A pancreas-sparing segmental duodenectomy was performed, and the duodenum reconstructed with an end-to-end anastomosis. Microscopically, the tumor was a well-differentiated adenocarcinoma, with no infiltration at the cut end of the accessory pancreatic duct. The postoperative course was uneventful and the patient discharged on postoperative day 11. We reviewed previously reported cases of carcinoma of the minor duodenal papilla. Early and exact preoperative diagnosis of duodenal neoplasms makes it possible to select a less invasive treatment, which also maintains curability.
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Affiliation(s)
- Toru Zuiki
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Hideki Sasanuma
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Masaru Koizumi
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Kunihiko Shimura
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yasunaru Sakuma
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Masanobu Hyodo
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Alan T Lefor
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
| | - Yoshikazu Yasuda
- Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan
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11
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Okubo Y, Wakayama M, Nemoto T, Kitahara K, Nakayama H, Shibuya K, Yokose T, Yamada M, Shimodaira K, Sasai D, Ishiwatari T, Tsuchiya M, Hiruta N. Literature survey on epidemiology and pathology of gangliocytic paraganglioma. BMC Cancer 2011; 11:187. [PMID: 21599949 PMCID: PMC3141762 DOI: 10.1186/1471-2407-11-187] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 05/20/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although gangliocytic paraganglioma (GP) has generally been regarded as a neuroendocrine tumor, its origin remains unclear. We therefore aimed to investigate the details of this disease by carefully analyzing and extracting common features of the disease as presented in selected publications. METHODS We searched for English and Japanese cases of GP using the PubMed and IgakuChuoZasshi databases on August 2010. We then extracted and sampled raw data from the selected publications and performed appropriate statistical analyses. Additionally, we evaluated the expression of hormone receptors based on our previously reported case. RESULTS 192 patients with GP were retrieved from the databases. Patient ages ranged from 15 y to 84 y (mean: 52.3 y). The gender ratio was 114:76 (male to female, 2 not reported). Maximum diameter of the tumors ranged from 5.5 mm to 100 mm (mean: 25.0 mm). The duodenum (90.1%, 173/192) was found to be the most common site of the disease. In 173 patients with duodenal GP, gastrointestinal bleeding (45.1%, 78/173) was found to be the most common symptom of the disease, followed by abdominal pain (42.8%, 74/173), and anemia (14.5%, 25/173). Rate of lymph node metastasis was 6.9% (12/173). Our statistical analysis indicated that significant differences were found for gender between GP within the submucosal layer and exceeding the submucosal layer. Furthermore, our immunohistochemical evaluation showed that both epithelioid and pancreatic islet cells showed positive reactivity for progesterone receptors. CONCLUSIONS Our literature survey revealed that there were many more cases of GP exceeding the submucosal layer than were expected. Meanwhile, our statistical analyses and immunohistochemical evaluation supported the following two hypotheses. First, vertical growth of GP might be affected by progesterone exposure. Second, the origin of GP might be pancreatic islet cells. However, it is strongly suspected that our data have been affected by publication bias and to confirm these hypotheses, further investigation is required.
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Affiliation(s)
- Yoichiro Okubo
- Department of Surgical Pathology, Toho University School of Medicine, 6-11-1 Omori-Nishi, Ota-Ku, Tokyo, 143-8541, Japan
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12
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Trevino JM, Wilcox CM, Varadarajulu S. Endoscopic resection of minor papilla adenomas (with video). Gastrointest Endosc 2008; 68:383-6. [PMID: 18582882 DOI: 10.1016/j.gie.2008.03.1070] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 03/09/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although there are several large series on endoscopic resection of the major duodenal papilla, only commentary on individual cases has been presented on endoscopic minor papilla resection. OBJECTIVE To evaluate the technical success and safety of endoscopy for resection of minor papilla adenomas. DESIGN Observational study. SETTING Academic tertiary-referral center. PATIENTS Consecutive patients referred for endoscopic resection of minor papilla adenomas over a 12-month period. INTERVENTIONS All patients underwent an EUS before an ERCP to exclude ductal involvement by the tumor and for evaluation of pancreatic-ductal anatomy. The minor papilla was removed by snare electrocautery in all patients. A pancreatic stent was placed in the dorsal duct in patients with pancreas divisum as a prophylaxis for post-ERCP pancreatitis. Complications were assessed per consensus criteria. MAIN OUTCOME MEASUREMENTS To evaluate the technical success and safety of endoscopy for resection of minor papilla adenomas. OBSERVATIONS Three patients underwent endoscopic resection of minor papilla adenomas over a 12-month period. The first patient had minor papilla adenoma, the second had coexisting pancreas divisum anatomy, and the third had adenomatous involvement of both the major and minor papillas. Minor papilla resection was technically successful in all 3 patients, with dual major and minor papilla resection in 1 patient who had adenomatous changes at both sites. Although 2 patients experienced no complications, the patient with pancreas divisum developed mild post-ERCP pancreatitis. At a 12-month follow-up, there was no evidence of tumor recurrence in any of the 3 patients. LIMITATION Small number of patients. CONCLUSIONS In experienced hands, endoscopic resection of the minor papilla is technically feasible, safe, and is associated with favorable clinical outcomes.
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Affiliation(s)
- Jessica M Trevino
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA
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13
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Kajiwara M, Fujii S, Takahashi S, Konishi M, Nakagohri T, Gotohda N, Kinoshita T. Adenocarcinoma of the minor duodenal papilla with intraepithelial spread to the pancreatic duct. Virchows Arch 2007; 451:1075-81. [PMID: 17805567 DOI: 10.1007/s00428-007-0496-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 07/31/2007] [Accepted: 08/01/2007] [Indexed: 01/13/2023]
Abstract
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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Affiliation(s)
- Masatoshi Kajiwara
- Department of Hepatobiliary Pancreatic Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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