No abstract

The accessory pancreatic duct (APD) is the smaller and less constant pancreatic duct. The patency of the APD was investigated clinically in an effort to determine its role in pancreatic pathophysiology. Dye-injection endoscopic retrograde pancreatography (ERP) was performed in 190 cases. In the patients who exhibited filling of the fine branches of the ducts on ERP, contrast medium with indigo carmine was injected into the major duodenal papilla. The patency of the APD was determined by observing the excretion of the dye from the minor duodenal papilla. Of the 123 control cases studied, 41 % had a patent APD. According to the shape of the terminal portion of the APD on accessory pancreatogram, it was classified as either the stick type (n = 63), branch type (n = 15), saccular type (n = 15), spindle type (n = 11), or cudgel type (n = 8). In these groups, 49, 0, 27, 82, and 87% of the APD were patent, respectively. The patency of the APD in the patients with acute pancreatitis was 6% (1 of 17). The difference in patency between this group and the control group was significant (p < 0.01). The patency of the APD varies with the shape of the terminal portion of the APD. A patent APD may prevent acute pancreatitis by lowering the pressure in the main pancreatic duct.

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We report multiple paraganglioneuromas which occurred in a 40-year-old-man. Thirty-two tumours with similar histological appearance have been reported previously and most of them showed a striking predilection to occur in the second portion of the duodenum. In this case, three masses were detected; one was located in the periampullary region of duodenum with a polypoid appearance, the others were well defined masses in peri-pancreatic tissue adjacent to large vessels. Histology revealed two cellular components, epithelioid cells with NSE immunoreactivity and S-100 protein containing spindle-shaped cells. Moreover, on electron microscopical examination, three different epithelioid cell types were seen. Type I was a figure differentiating to ganglion cells, type II to paraganglion cells, type III was a hybrid form of ganglion and paraganglion cells. Paraganglioneuroma revealed the histopathology of ganglioneuroma, paraganglioma and also a mixed appearance. In this respect the tumour may be considered to originate in undifferentiated neural crest cells and develop organoid differentiation.

A case of so‐called “papillary and cystic neoplasm of the pancreas” (PCNP) was reported and investigated immunohistochemically and ultrastructurally. A tumor of the pancreatic head in a 21‐year‐old female was curatively resected. The tumor was cystic and histologically consisted of uniform cells in papillary and solid structure. Although there was no immunoreactivity for pancreatico‐gut hormones or secretory products of the pancreas in the tumor cells, most of the tumor cells were diffusely immunoreactive for neuron‐specific enolase (NSE). Some neurosecretory granules were detected in the tumor cells ultrastructurally. Both facts suggested endocrine cell character of the tumor. Certain cases of PCNP might show a differentiation to endocrine cells.