PDF(Pubmed)
Abstract：
BACKGROUND: Aberrant pancreatic tissue in the gastrointestinal tract is a relatively common finding. However, malignant transformation is extremely rare. Herein, we report a case of ectopic pancreatic ductal adenocarcinoma in the stomach wall.
METHODS: A 38 year old male presented with nausea, bloating, abdominal distention and weight loss for 4 months.
METHODS: Endoscopy of upper gastrointestinal tract was performed twice with 2 months interval and a stenotic pyloric part was observed with a suspected submucosal lesion. It was sampled both times, however the pathology findings of the mucosal biopsies were unremarkable with no identifiable neoplastic structures. CT scan and MRI was performed and showed a thickened pyloric wall with a submucosal lesion 15 × 15 mm in diameter. Blood levels of tumor markers carcinoembrionic antigen and carbohydrate antigen 19-9 were within a normal range.
METHODS: Pyloric stenosis progressed and the patient underwent a Billroth type I distal gastric resection with D2 lymphadenectomy. Pathologic examination revealed a well differentiated ductal adenocarcinoma arising in the heterotopic pancreatic tissue (Heinrich type III). The resection margins and lymph nodes were free of tumor. The patient received adjuvant chemotherapy with 6 courses of XELOX.
RESULTS: No disease recurrence is reported in 12 months follow-up.
CONCLUSIONS: Aberrant pancreatic ductal adenocarcinoma in the stomach is a rare finding, however this pathology should be included in the differential diagnosis of gastric submucosal lesion causing pyloric stenosis.
METHODS: A 38 year old male presented with nausea, bloating, abdominal distention and weight loss for 4 months.
METHODS: Endoscopy of upper gastrointestinal tract was performed twice with 2 months interval and a stenotic pyloric part was observed with a suspected submucosal lesion. It was sampled both times, however the pathology findings of the mucosal biopsies were unremarkable with no identifiable neoplastic structures. CT scan and MRI was performed and showed a thickened pyloric wall with a submucosal lesion 15 × 15 mm in diameter. Blood levels of tumor markers carcinoembrionic antigen and carbohydrate antigen 19-9 were within a normal range.
METHODS: Pyloric stenosis progressed and the patient underwent a Billroth type I distal gastric resection with D2 lymphadenectomy. Pathologic examination revealed a well differentiated ductal adenocarcinoma arising in the heterotopic pancreatic tissue (Heinrich type III). The resection margins and lymph nodes were free of tumor. The patient received adjuvant chemotherapy with 6 courses of XELOX.
RESULTS: No disease recurrence is reported in 12 months follow-up.
CONCLUSIONS: Aberrant pancreatic ductal adenocarcinoma in the stomach is a rare finding, however this pathology should be included in the differential diagnosis of gastric submucosal lesion causing pyloric stenosis.
摘要：
背景：胃肠道中的胰腺组织异常是一个相对常见的发现。然而,恶性转化极为罕见。在这里，我们报告一例胃壁异位胰腺导管腺癌。
方法：一名38岁男性出现恶心，腹胀,腹胀和体重减轻4个月。
方法：上消化道内镜检查两次，间隔2个月，观察到狭窄的幽门部分，怀疑粘膜下病变。它被采样了两次，然而,粘膜活检的病理结果不明显,没有可识别的肿瘤结构.进行CT扫描和MRI检查，显示幽门壁增厚，粘膜下病变直径15×15mm。肿瘤标志物癌胚抗原和碳水化合物抗原19-9的血液水平在正常范围内。
方法：幽门狭窄进展，患者接受了Billroth型I型远端胃切除术和D2淋巴结清扫术。病理检查显示，异位胰腺组织中出现了高分化的导管腺癌（HeinrichIII型）。切除边缘及淋巴结均无肿瘤。患者接受6个疗程的XELOX辅助化疗。
结果：在12个月的随访中没有报告疾病复发。
结论：胃胰腺导管腺癌异常是一种罕见的发现，然而，这种病理应包括在引起幽门狭窄的胃粘膜下病变的鉴别诊断中。
方法：一名38岁男性出现恶心，腹胀,腹胀和体重减轻4个月。
方法：上消化道内镜检查两次，间隔2个月，观察到狭窄的幽门部分，怀疑粘膜下病变。它被采样了两次，然而,粘膜活检的病理结果不明显,没有可识别的肿瘤结构.进行CT扫描和MRI检查，显示幽门壁增厚，粘膜下病变直径15×15mm。肿瘤标志物癌胚抗原和碳水化合物抗原19-9的血液水平在正常范围内。
方法：幽门狭窄进展，患者接受了Billroth型I型远端胃切除术和D2淋巴结清扫术。病理检查显示，异位胰腺组织中出现了高分化的导管腺癌（HeinrichIII型）。切除边缘及淋巴结均无肿瘤。患者接受6个疗程的XELOX辅助化疗。
结果：在12个月的随访中没有报告疾病复发。
结论：胃胰腺导管腺癌异常是一种罕见的发现，然而，这种病理应包括在引起幽门狭窄的胃粘膜下病变的鉴别诊断中。
