J Korean Med Sci.  2004 Feb;19(1):145-148. 10.3346/jkms.2004.19.1.145.

Adenocarcinoma Arising in Gastric Heterotopic Pancreas: A Case Report

• Song DE
• Kwon Y
• Kim KR
• Oh ST
• Kim JS

• KMID: 1785711
• DOI: http://doi.org/10.3346/jkms.2004.19.1.145

Abstract

A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. Esophagogastroduodenoscopy revealed a submucosal tumor with an irregular central umbilication in the gastric antrum. A wedge resection specimen demonstrated a submucosal oligolocular cystic mass (1.7x1.4x1.2 cm) with a solid portion. Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures. The adenocarcinoma components in the solid area infiltrated the proper muscle and the overlying mucosa of the stomach. The transitional area between the benign ductal structures and the adenocarcinoma component was found. The follow-up course was uneventful 5 months postoperatively.

Keyword

Adenomyoma; Stomach Neoplasms; Adenocarcinoma

MeSH Terms

Adenocarcinoma/complications/*diagnosis/pathology
Adenomyoma/pathology
Adult
Autopsy
Choristoma
Epithelium/pathology
Gastric Mucosa/pathology
Human
Male
Pancreas/*abnormalities
Pancreatic Neoplasms/complications/*diagnosis/pathology
Time Factors

Figure

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  Fig. 1 The EGD shows a submucosal tumor with an irregular central umbilication in the gastric antrum.

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  Fig. 2 The abdominal CT reveals a well-demarcated multiseptate cystic mass (arrows) in the gastric antrum.

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  Fig. 3 The submucosal mass consists of oligolocular cystic (arrows) and solid areas without overlying mucosal change (H&E stain, ×10).

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  Fig. 4 The cystic area (arrows in Fig. 3) shows dilated benign ductal structures lined by cuboidal epithelium (A, H&E stain, ×200) and focal periductal glandular structures without islet cell islands (B, H&E stain, ×100).

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  Fig. 5 The solid area shows well to moderately differentiated adenocarcinoma with an adjacent dysplastic change in the lining cells of the dilated ductal structures (H&E stain, ×40).

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  Fig. 6 Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40).

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