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

Abstract

Gastric ectopic pancreas is an uncommon developmental anomaly and its histological diagnosis is usually difficult by using a conventional biopsy forceps. In the literature, most cases of gastric ectopic pancreas were usually diagnosed by gross pattern during endoscopic examination or features of endoscopic ultrasound. In contrast, this disease was seldom diagnosed by histology in clinical practice. Although the typical endoscopic ultrasonographic features of ectopic pancreas include heterogeneous echogenicity, indistinct borders, and a location within 2 or more layers, it can also exhibit hypoechoic homogeneous echogenicity and a distinct border within the fourth sonographic layer (muscularis propria) similar to the endoscopic ultrasonographic features of gastrointestinal stromal tumors. In our study, we found that 53% of gastric ectopic pancreas originated within the fourth sonographic layer, demonstrating hypoechoic, homogeneous echogenicity, and distinct borders. Therefore, recognizing endoscopic ultrasonographic features, combining with deep biopsy, endoscopic ultrasound-guided fine needle aspiration/core needle biopsy can prevent conducting unnecessary resection. Surgical resection is the mainstay treatment for symptomatic gastric ectopic pancreas, but endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection technique provides an alternative method of removing superficial-type and deep-type gastric ectopic pancreas.

A case of gastric heterotopic pancreas with gastroduodenal invagination

“…The HP tissue can undergo secondary changes and complications such as acute pancreatitis, pseudo-cyst formation, development of mucinous cysts, and pancreatic intra-epithelial neoplasia [7, 19, 24–26]. Rare cases of ectopic pancreatic tissue complicated by adenocarcinoma or even endocrine tumors have been described.…”

Duodenal Heterotopic Pancreas with a Large Retention Cyst: A Case Report and Literature Review

“…HP is a relatively common congenital anomaly that is reported in 1%-2% of autopsy cases (2) and is observed in 1 in every 500 upper abdominal operations (3). Most HP cases are asymptomatic and benign; however, malignant transformation or inflammation may cause adverse symptoms and bleeding (4). HP-forming retention cysts have frequently been reported in the stomach but are very rare in the duodenum (5,6).…”

A rare case of enlarged gastric heterotopic pancreas with retention cysts: A case report and literature review

“…HP is a relatively common congenital anomaly that is reported in 1–2% of autopsy cases [ 1 ]. Although the majority of HP cases are asymptomatic and benign, symptoms or bleeding may be caused by malignant transformation or inflammation [ 2 ].…”