Ductal Adenocarcinoma Arising from the Heterotopic Pancreas Situated in the Jejunum

Um, Jun Won; Joe, Yong Geul; Kim, In Sun; Bae, Jeoung Won

Abstract

A heterotopic or ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Pancreatic heterotopia is characterized by the presence of pancreatic acinar, islet, and ductular elements. Most examples are incidentally encountered during surgery, and, on rare occasions, epigastric pain, weight loss, hemorrhage, gastric outlet obstruction, and intussusception have been directly attributable to the presence of the heterotopic pancreas. A malignant transformation in an ectopic pancreas is exceptional and intestinal obstruction of the small bowel by an adenocarcinoma arising in an ectopic pancreas has not been reported yet. We present the case of a ductal adenocarcinoma originating in the heterotopic pancreas in the jejunum of a 73-year-old man. The tumor was found to obstruct the jejunum at a distance of about 25 cm distal to the ligament of Treitz. The resected jejunum histologically showed a ductal adenocarcinoma that originated from the ectopic pancreas. To our knowledge, this would be the first case in Korea, which the patient presented with a small bowel obstruction due to a malignant transformation of an ectopic pancreas.