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

• Yoon JB
• Lee BE
• Kim DH
• Park DY
• Jeon HK
• Baek DH
• Kim GH
• Song GA

• KMID: 2410988
• DOI: http://doi.org/10.5946/ce.2017.055

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

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  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.

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  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.

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  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).

Reference

1. Hickman DM, Frey CF, Carson JW. Adenocarcinoma arising in gastric heterotopic pancreas. West J Med. 1981; 135:57–62.

2. De Castro Barbosa JJ, Dockerty MB, Waugh JM. Pancreatic heterotopia; review of the literature and report of 41 authenticated surgical cases, of which 25 were clinically significant. Surg Gynecol Obstet. 1946; 82:527–542.

3. Hammock L, Jorda M. Gastric endocrine pancreatic heterotopia: report of a case with histologic and immunohistochemical findings and review of the literature. Arch Pathol Lab Med. 2002; 126:464–467.

4. Lack EE. Congenital and developmental abnormalities of the pancreas. In : Lack EE, editor. Pathology of the pancreas, gallbladder, extrahepatic biliary tract, and ampullary region. Oxford: Oxford University Press;2003. p. 44–62.

5. Song DE, Kwon Y, Kim KR, Oh ST, Kim JS. Adenocarcinoma arising in gastric heterotopic pancreas: a case report. J Korean Med Sci. 2004; 19:145–148.

6. Chou JW, Cheng KS, Ting CF, Feng CL, Lin YT, Huang WH. Endosonographic features of histologically proven gastric ectopic pancreas. Gastroenterol Res Pract. 2014; 2014:160601.

7. Guillou L, Nordback P, Gerber C, Schneider RP. Ductal adenocarcinoma arising in a heterotopic pancreas situated in a hiatal hernia. Arch Pathol Lab Med. 1994; 118:568–571.

8. Makhlouf HR, Almeida JL, Sobin LH. Carcinoma in jejunal pancreatic heterotopia. Arch Pathol Lab Med. 1999; 123:707–711.

9. Murabayashi T, Kawaguchi S, Okuda N, Oyamada J, Yabana T. Early gastric cancer just above a heterotopic pancreas. Case Rep Gastroenterol. 2016; 10:308–314.