title: Adenocarcinoma arising in a heterotopic pancreas (Heinrich type III): a case report.
abstract: BACKGROUND
  Heterotopic pancreatic cancer in the duodenum is a very rare disease. Only twelve cases have been reported worldwide to date. We report a rare case of malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum with long-term survival of the patient, and review the 12 cases in the literature.
  
  
  METHODS
  A 75-year-old Japanese man was admitted to our hospital complaining of nausea and vomiting. Endoscopy and upper gastrointestinal contrast study showed marked duodenal stenosis. A pylorus-preserving pancreaticoduodenectomy was performed. Histopathological examination of the surgically resected specimen showed malignant transformation of heterotopic pancreas (Heinrich type III) in the duodenum. The postoperative course was uneventful, and the patient was discharged from the hospital on postoperative day 30. He is well and shows no signs of recurrence at the time of writing, six years after the surgery.
  
  
  CONCLUSIONS
  Adenocarcinoma arising within the heterotopic pancreas appears to be rare. It is difficult to obtain a correct diagnosis preoperatively. The management of heterotopic pancreas depends on the presence or absence of symptoms. If the patient is asymptomatic or benign, conservative treatment with regular follow-up is recommended. When the patient is symptomatic or there is a suspicion of malignancy, surgical management with intra-operative frozen section diagnosis is indicated.
authors.affiliation: Department of General and Gastroenterological Surgery, Osaka Medical College Hospital, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan. sur001@poh.osaka-med.ac.jp.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inoue
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Arisaka
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Higuchi
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Egashira
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Tanigawa