A case of ectopic pancreas of the stomach accompanied by intraductal papillary mucinous neoplasm with GNAS mutation

Nambu, Naoko; Yamasaki, Takashi; Nakagomi, Nami; Kumamoto, Tsutomu; Nakamura, Tatsuro; Tamura, Akio; Tomita, Toshihiko; Miwa, Hiroto; Shinohara, Hisashi; Hirota, Seiichi

doi:10.1186/s12957-021-02424-x

Cited by 3 publications

(2 citation statements)

References 22 publications

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“…Heterotopic pancreas is typically a benign disease that does not require aggressive surgical resection. Although heterotopic pancreas may result in bleeding, pancreatitis, intraductal papillary mucinous neoplasm (IPMN) ( 9 ), and other lesions, heterotopic pancreas is associated with a favorable prognosis in most patients. Malignant transformation of heterotopic pancreas is considered a rare event, with a reported incidence of 0.7%–1.8% ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review

Qi,

Li,

Shi

2024

Front. Surg.

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Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.

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Section: Discussionmentioning

confidence: 99%

Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review

Qi,

Li,

Shi

2024

Front. Surg.

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“…Immunohistochemistry for MUCs shows MUC1 (+)/MUC2 (−)/MUC5AC (+)/MUC6 (+) in pancreatobiliary and oncocytic types. [2,[19][20][21] Approximately 65% of the BD-IPMNs are of gastric type. [22] However, if IPMN has a tendency towards malignant change, the histological subtypes of BD-IPMNs are usually tubular type.…”

Section: Discussionmentioning

confidence: 99%

Intraductal papillary mucinous neoplasm of the accessory pancreatic duct in the pancreas uncinate process: A case report

Guo,

Liu,

Yang

et al. 2023

Medicine

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Rationale: Intraductal papillary mucinous neoplasms (IPMN) of the accessory pancreatic duct (APD) are very rare and their clinical significance is not known. Here, we describe a case of IPMN originating in a branch of the duct of APD within the uncinate process of the pancreas, which initially presented with acute pancreatitis.Patient concerns: A 70-year-old man visited our medical center presenting with acute pancreatitis around the head and uncinate process of the pancreas.Diagnoses: Computer tomography scans revealed the presence of a 35-mm cystic mass-like lesion within the pancreas uncinate process communicating with a branch of the APD. The patient was diagnosed with APD-IPMN in the pancreas uncinate process accompanied by acute pancreatitis.Interventions: Conservative management of the acute pancreatitis relieved his symptoms, while duodenum-preserving partial pancreatic head resection (DPPHR-P) was performed to treat the APD-IPMN. Intraoperative exploration showed the presence of severe adhesions within the uncinate process of the pancreas and that the tumor's "peduncle" -a branch of the duct of APD -was saddling just at the front of the main pancreatic ducts. Thus, surgical removal of the tumor required special handling of the region between the main duct (MD) and APD to protect the integrity of the main pancreatic ducts. Finally, a 35*30*15 mm IPMN was successfully removed and the MD was preserved combined with ligation from the root of the APD of the pancreas. The drainage volume of the ventral tube increased by around 20-fold in 24 hours on the fourth day after surgery. The presence of high amylase levels in the drainage discharge (40713.5 U/L) led to the diagnosis of postoperative pancreatic fistula (POPF). The drainage volume remained high for 3 days.Outcomes: The patient was discharged and POPF was successfully managed through endoscopic pancreatic duct stenting.Lessons: APD-IPMN in the pancreas uncinate process has its own characteristics of localized pancreatitis, and MD-preserving DPPHR-P not only protects the exocrine and endocrine functions of the pancreas, but it also protects the physiological and anatomical integrity. The appearance of POPF after DPPHR-P may be managed by endoscopic pancreatic duct stenting.

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Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

Zheng,

Huang,

et al. 2023

World J Gastrointest Surg

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BACKGROUND Gastric ectopic pancreas (GEP) is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas. It is usually difficult to diagnose through histological examination, and the choice of treatment method is crucial. AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection (LR) and endoscopic submucosal dissection (ESD). METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included. Data on clinical characteristics, endoscopic ultrasonography (EUS), ESD, and LR were collected and analyzed. The characteristics of EUS and the efficacy of the two treatments were analyzed. RESULTS The average age of the patients was 43.31 ± 13.50 years, and the average maximum diameter of the lesions was 1.55 ± 0.70 cm. The lesion originated from the mucosa in one patient (2.04%), from the submucosa in 42 patients (85.71%), and from the muscularis propria in 6 patients (12.25%). Twenty-nine patients (59.20%) with GEP showed umbilical depression on endoscopy. The most common initial symptom of GEP was abdominal pain (40.82%). Tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-19-9), were generally within the normal range. One patient (2.04%) with GEP had increased CEA and CA-19-9 levels. However, no cancer tissue was found on postoperative pathological examination, and tumor markers returned to normal levels after resecting the lesion. There was no significant difference in surgery duration (72.42 ± 23.84 vs 74.17 ± 12.81 min) or hospital stay (3.70 ± 0.91 vs 3.83 ± 0.75 d) between the two methods. LR was more often used for patients with larger tumors and deeper origins. The amount of bleeding was significantly higher in LR than in ESD (11.28 ± 16.87 vs 16.67 ± 8.76 mL, P < 0.05). Surgery was associated with complete resection of the lesion without any serious complications; there were no cases of recurrence during the follow-up period. CONCLUSION GEP has unique characteristics in EUS. LR and ESD seem to be good choices for treating GEP. LR is better for large GEP with a deep origin. However, due to the rarity of GEP, multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.

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A case of ectopic pancreas of the stomach accompanied by intraductal papillary mucinous neoplasm with GNAS mutation

Cited by 3 publications

References 22 publications

Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review

Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review

Intraductal papillary mucinous neoplasm of the accessory pancreatic duct in the pancreas uncinate process: A case report

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

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