Adenocarcinoma arising from an ectopic pancreas in the duodenum: a case report

Kaneko, Tsukasa; Ohara, Masanori; Okamura, Kunishige; Fujiwara-Kuroda, Aki; Miyasaka, Daisuke; Yamabuki, Takumi; Takahashi, Ryōsuke; Komuro, Kazuteru; Suzuoki, Masato; Iwashiro, Nozomu; Kato, Mototsugu; Kimura, Noriko; Kijima, Hiroshi; Nakamura, Tõru; Hirano, Satoshi

doi:10.1186/s40792-019-0684-8

Cited by 19 publications

(20 citation statements)

References 18 publications

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“…There are limited reports of adjuvant therapy following oncological resection of these tumours. Hickman et al describe that the course of ectopic pancreatic carcinomas within the stomach appear to behave like primary gastric cancers and suggest that they be managed in a similar fashion [21], while other patients underwent adjuvant chemotherapy similar to that for pancreatic cancer [22]. There is no available literature on the efficacy of chemotherapy for adenocarcinoma arising from a heterotopic pancreas [23].…”

Section: Discussionmentioning

confidence: 99%

Malignant Transformation of Heterotopic Pancreatic Tissue in a Patient with BRCA2 Mutation

Yeo

Goh

Chuah

et al. 2021

Gastroenterology Insights

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Background: Malignant transformation of heterotopic pancreatic tissue is a rare entity with only several case reports published in the scientific literature. Adjuvant chemotherapy following oncological resection for lesions with nodal metastasis has not been well described and there are no guidelines available to guide the management of these patients. Case Presentation: We present a case of gastric heterotopic pancreatic carcinoma with nodal metastasis in a young patient with breast cancer gene (BRCA) 2 mutation. He had undergone a laparoscopic wedge resection for a gastric lesion initially thought to be a gastrointestinal stroma tumor. Given the involvement of the wedge resection margins, the patient underwent a distal gastrectomy with oncological lymph nodal clearance. One out of the 33 harvested lymph nodes harboured micrometastasis while the main gastrectomy specimen did not have any residual malignancy. Following the histological diagnosis, he received an adjuvant chemotherapy regime akin to that prescribed for locally advanced pancreatic adenocarcinoma with good response. This is, to our knowledge, also the first such case report in a patient with BRCA2 mutation. Conclusions: Pre-operative diagnostic confirmation is challenging and endoscopic procedures pose significant false negatives. Reports of nodal metastasis following oncological resection are limited and there are no guidelines regarding adjuvant therapies. We would recommend a chemotherapy regimen similar to that for primary locally advanced pancreatic carcinoma in patients found to have nodal metastasis.

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Section: Discussionmentioning

confidence: 99%

Malignant Transformation of Heterotopic Pancreatic Tissue in a Patient with BRCA2 Mutation

Yeo

Goh

Chuah

et al. 2021

Gastroenterology Insights

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“…(3) Non-neoplastic pancreatic tissue must comprise at least fully developed acini and ductal structures. We found 12 other case reports of HP cancer on PubMed records from the year 2000 to 2020, as shown in Table 1 [3,5,[7][8][9][10][11][12][13][14][15]. In those reports, the patients' mean age was 69.7 years (range, 56-86 years).…”

Section: Discussionmentioning

confidence: 99%

Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report

et al. 2020

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Background: Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum. Case presentation: A 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumorspecific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing. Conclusions: HP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended.

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“…14,15 In the literature, malignancy was reported to develop in EPT in 52 cases. 16 Therefore, complete excision of the incidentally found pancreatic tissue is the treatment of choice. Because there are very few reported cases, clinical and radiological features are not well defined.…”

Section: Discussionmentioning

confidence: 99%

Ectopic Pancreas Tissue in the Gallbladder: An Incidental Mass in Laparoscopy

Özden

Gömeç²,

Kurtulan

2020

Arch Iran Med

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Ectopic pancreatic tissue (EPT) is a congenital pancreatic tissue located in a location other than the normal anatomical site of the pancreas. It is usually asymptomatic and can be detected during surgical procedures or postoperatively in pathology examinations. The importance of EPT is the possibility of malignant transformation, although rare. It can mimic malignant masses. Since preoperative diagnosis is often unlikely, resection is the preferred method. We report a case with gallstones who underwent elective cholecystectomy. EPT was detected in the gallbladder.

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Adenocarcinoma arising from an ectopic pancreas in the duodenum: a case report

Cited by 19 publications

References 18 publications

Malignant Transformation of Heterotopic Pancreatic Tissue in a Patient with BRCA2 Mutation

Malignant Transformation of Heterotopic Pancreatic Tissue in a Patient with BRCA2 Mutation

Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report

Ectopic Pancreas Tissue in the Gallbladder: An Incidental Mass in Laparoscopy

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