Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2020; 8(10): 1979-1987
Published online May 26, 2020. doi: 10.12998/wjcc.v8.i10.1979
Heterotopic pancreas adenocarcinoma in the stomach: A case report and literature review
Yao Xiong, Yue Xie, Dan-Dan Jin, Xin-Ying Wang
Yao Xiong, Yue Xie, Dan-Dan Jin, Xin-Ying Wang, Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
Author contributions: Wang XY conceptualized the case report; Xiong Y and Jin DD performed the literature investigation; Xie Y and Xiong Y drafted the manuscript; Xiong Y and Wang XY revised and edited the manuscript for important intellectual content; all authors provided approval of the final draft for submission.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xin-Ying Wang, PhD, Chief Physician, Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, 253 Gongye Road, Guangzhou 510280, Guangdong Province, China. helenwxy@smu.edu.cn
Received: February 20, 2020
Peer-review started: February 20, 2020
First decision: March 5, 2020
Revised: April 11, 2020
Accepted: April 17, 2020
Article in press: April 17, 2020
Published online: May 26, 2020
Processing time: 94 Days and 20.6 Hours
Abstract
BACKGROUND

Heterotopic pancreas is a common lesion found in the gastrointestinal tract and is usually considered a benign disease. Reports of malignant change of heterotopic pancreas are scarce.

CASE SUMMARY

A 44-year-old Chinese female underwent a gastroscopy to assess abdominal distension that had persisted for 2 months. A protruding lesion in the gastric antrum was revealed but no malignant tissue was found in the biopsy specimen. The patient's symptom persisted and progressed to repeated vomiting. Endoscopy after 4 months revealed obstruction of the gastric outlet caused by the protruding lesion. A distal gastrectomy was performed. Histopathological examination of the surgical specimen showed the malignant transformation of aberrant pancreas in the stomach. Chemotherapy consisting of folinic acid, fluorouracil, and oxaliplatin was administered for three cycles, and was changed to gemcitabine monotherapy because of adverse effects and increased serum tumor marker levels. The patient remained asymptomatic during a 12-month follow-up.

CONCLUSION

Pancreatic heterotopy should be considered as source of a potentially malignant lesion, and early treatment or close monitoring for aberrant pancreas is recommended.

Keywords: Stomach; Pyloric obstruction; Heterotopic pancreas; Adenocarcinoma; Case report

Core tip: Heterotopic pancreas is usually considered a benign disease. We here present a rare case of heterotopic pancreas in the stomach with malignant change in a middle-aged female patient. Endoscopy revealed a protruding lesion in the gastric antrum which caused gastric outlet obstruction. The malignant transformation was not diagnosed until the lesion was excised surgically and examined by pathology. This case emphasizes the importance of early treatment or close monitoring for aberrant pancreas to avoid the potential cancerization and highlights that a protruding lesion in the stomach should prompt suspicion of a malignant pancreatic heterotopia.