The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Large Neuroendocrine Tumor of the Major Duodenal Papilla Removed by Endoscopic Papillectomy

내시경 유두절제술로 제거한 거대 십이지장 주유두의 신경내분비종양

  • Bae, Seung-Hyeon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jin Yong (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Chang Lae (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Young Kwon (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Bo Mi (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Seung-Mo (Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Myung-Hwan (Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 배승현 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김진용 (울산대학교 의과대학 서울아산병원 내과) ;
  • 김창래 (울산대학교 의과대학 서울아산병원 내과) ;
  • 최영권 (울산대학교 의과대학 서울아산병원 내과) ;
  • 신보미 (울산대학교 의과대학 서울아산병원 내과) ;
  • 홍승모 (울산대학교 의과대학 서울아산병원 병리과) ;
  • 김명환 (울산대학교 의과대학 서울아산병원 내과)
  • Received : 2013.04.17
  • Accepted : 2013.05.09
  • Published : 2014.03.01
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Abstract

Neuroendocrine tumors (NET) of the major duodenal papilla are rare and the natural history of this disease is not clear. We experienced a case in a 31-year-old male. Duodenoscopy revealed an enlarged major duodenal papilla with central umbilication and nodularity. Endoscopic ultrasonography (EUS) demonstrated a 3-cm hypoechoic mass that was confined to the submucosa. A biopsy led to the diagnosis of a grade 1 NET. The patient refused surgery, so we performed an endoscopic papillectomy. The tumor was removed completely. The resected specimen confirmed the diagnosis of a well-differentiated NET and all resection margins were negative. Surgical resection is currently considered to be the gold standard for the treatment of a large NET of the major duodenal papilla; however, endoscopic resection is a possible treatment modality for patients at high surgical risk or who are reluctant to undergo surgery.

십이지장 주유두의 신경내분비종양은 드문 종양이지만 크기에 관계없이 세포 분화도가 나쁜 경우 다른 장기에 전이를 일으킬 수 있어 치료 방법으로 췌-십이지장 절제술이 권유되고 있다. 이번 증례는 십이지장 주유두에 발생한 3 cm 크기의 신경내분비종양을 수술 대신 덜 침습적인 내시경 유두절제술을 시행하여 종양을 완전히 절제할 수 있었다. 주유두 신경내분비종양에 있어서 수술에 대한 위험도가 높거나 환자가 수술을 원치 않는 경우에 내시경 유두절제술이 대안이 될 수 있겠다.

Keywords

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  1. A Case of Ampullary Neuroendocrine Tumor Treated by Endoscopic Papillectomy vol.19, pp.4, 2014, https://doi.org/10.15279/kpba.2014.19.4.204