Korean J Gastroenterol.  2020 Jul;76(1):37-41. 10.4166/kjg.2020.76.1.37.

Gastric Adenocarcinoma Arising from Heterotopic Pancreas Presenting as Gastric Outlet Obstruction 10 Years after the First Diagnosis

• Jung HS
• Lee J
• Nam KH
• Jeong SJ
• Oh EH
• Park YE
• Park J
• Kim TO

• KMID: 2504592
• DOI: http://doi.org/10.4166/kjg.2020.76.1.37

Abstract

Gastric heterotopic pancreas is a relatively uncommon incidental finding. On the other hand, the presentation of gastric adenocarcinoma arising from a heterotopic pancreas is rare. This paper reports a case of gastric adenocarcinoma arising from a heterotopic pancreas that presented as a gastric outlet obstruction 10 years after the initial diagnosis of a suspicious submucosal tumor. Endoscopy revealed a pyloric stricture with prepyloric wall thickening and a complete gastric outlet obstruction. Abdominal and pelvic computed tomography exposed a severely distended gastric lumen at the antrum with heterogeneously enhancing circumferential wall thickening in the prepyloric antrum and pylorus. Because conservative treatment was ineffective and a malignancy could not be excluded, laparoscopic subtotal gastrectomy with a gastrojejunostomy was performed for histological confirmation and treatment. The histopathology diagnosis was advanced gastric carcinoma arising from heterotopic pancreatic tissue.

Keyword

Pancreas; Stomach neoplasm; Adenocarcinoma; Gastric outlet obstruction

Figure

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  Fig. 1 Endoscopic and EUS images in 2008. (A-C) Endoscopic images showing a lobulated lesion with central umbilication. (D) EUS image showing an indistinct, heterogeneous, and intermediate hypoechoic lesion involving the second and third layers of the stomach (arrow). EUS, endoscopic ultrasonography.

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  Fig. 2 Endoscopic images on periodic follow-up endoscopy (A) 2011, (B) 2014, and (C) 2016.

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  Fig. 3 Endoscopic and contrast-enhanced abdominal computed tomography (CT) images at 2019. (A) Endoscopic image showing an approximately 3 cm sized submucosal lesion and pylorus narrowing. (B) CT image showing a severe distended gastric lumen at the antrum with heterogeneously enhancing circumferential wall thickening in the pre-pyloric antrum and pylorus (arrow).

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  Fig. 4 Gross and histopathology findings. (A) Cut sections of the whitish solid mass that invaded the subserosa. (B) The tumor showed well to poorly differentiated glands in the heterotopic pancreas. Non-neoplastic heterotopic pancreas (arrows) consisting of ducts and acini in the submucosa on the upper right side (H&E stain, ×1.25). (C) Photomicrograph of histopathology specimen shows heterotopic pancreatic tissue consisting of ducts (arrow) and acini (arrowhead). Well-differentiated adenocarcinoma is noted (on the left) (H&E stain, ×100). (D) High grade pancreatic intraepithelial neoplasia (PanIN) is characterized by papillary elements lined by cells with significant cytologic atypia (arrowhead) and low-grade PanIN (arrow) shows duct lined by flat epithelium composed of tall columnar mucin-producing cells with no cytologic atypia. Moderately differentiated malignant glands infiltrating into the fibrotic stroma (on the left side) (H&E, ×200).

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