Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature

Abstract

A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN) arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall.

Multicentric paraspinal neuroglial heterotopia with Müllerian and renal agenesis: a variant of Mayer-Rokitansky-Küster-Hauser syndrome?

“…Heterotopia is usually an incidental finding, but it can be confused clinically with a neoplasm. In exceptional cases, true neoplasms may arise from heterotopic tissues [ 8 , 9 ].…”

Intestinal Heterotopic Pancreas Involved by Simultaneous PanIN-2 Lesion and Endocrine Microadenoma: a Unique Case

“…For the differential diagnosis of the PanIN lesions, IPMN should be considered. The distinction between PanIN and IPMN is currently based on size and macroscopic appearance [16]; IPMN is a larger, visible lesion (> 1cm), possibly associated with other type of precursors or invasive tumors. The cytoarchitectural atypia present in our case was not prominent as that seen in carcinoma, and repeating the examined sections we did not see any association.…”

“…Heterotopic pancreas should be considered in the differential diagnosis of gastrointestinal submucosal masses and retroperitoneal tumors and the treatment of choice for all these patients is resection due to possible presence of premalignant or malignant lesions. Moreover, a supplementary attention needs to be given for other exocrine pancreatic lesions, because concomitant neoplastic precursors for ductal lesions have been described in HP and in morphologically normal pancreas [16].…”

Adenocarcinoma with Intraductal Papillary Mucinous Neoplasm Arising in Jejunal Heterotopic Pancreas

“…The other cases included mucinous cystadenocarcinoma, neuroendocrine carcinoma, anaplastic carcinoma, acinar cell carcinoma, solid pseudopapillary neoplasm, and mixed acinar endocrine carcinoma arising from heterotopic pancreatic tissue in the duodenum, jejunum, spleen, esophagus, ampulla of Vater, and mesocolon 7. Only five cases of IPMN arising in heterotopic pancreas of stomach (four cases) and Meckel's diverticulum (one case) have been reported 8-12. Neoplasms in jejunal heterotopic pancreas are extremely rare.…”