Clin Endosc.  2018 Mar;51(2):192-195. 10.5946/ce.2017.055.

A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas

Affiliations
  • 1Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. bongsul@pusan.ac.kr
  • 2Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
  • 3Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

Abstract

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

Keyword

Early gastric cancer; Heterotopic pancreas; Ectopic pancreas; Endosonography

MeSH Terms

Adenocarcinoma
Biopsy
Endoscopy, Digestive System
Endosonography
Female
Gastrectomy
Humans
Middle Aged
Mucous Membrane
Pancreas*
Pyloric Antrum
Stomach
Stomach Neoplasms*

Figure

  • Fig. 1. Endoscopic findings. (A, B) A subepithelial mass measuring 2.0×1.5 cm on the posterior wall of the distal antrum, and a 1-cm erythematous discoloration with erosion was noted on the surface of the mass. (C, D) Endoscopic ultrasonography revealed a 1.3×0.6-cm heterogeneously hypoechoic mass with indistinct margins located in the second and third layers of the gastric wall; anechoic cystic or tubular structures were observed within the mass, which were suggestive of heterotopic pancreas. The carcinoma appeared to be confined to the gastric mucosa.

  • Fig. 2. Abdominal computed tomographic findings. (A, B) A 1.4×1.0-cm protruding mass was observed at the distal antrum without lymph node or distant metastases.

  • Fig. 3. Microscopic findings. (A) An early gastric cancer (round mark) confined to the lamina propria and a separate underlying heterotopic pancreas were observed (Hematoxylin and eosin [H&E], ×40). (B) Atypical glandular cells showed hyperchromatic nuclei with prominent nucleoli, a finding that was consistent with moderately differentiated tubular adenocarcinoma (H&E, ×200). (C) The heterotopic pancreas was composed of acinar cells and ductal components, without dysplastic or malignant changes (H&E, ×200).


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