Premalignant lesion of heterotopic pancreas combined with gastritis cystica profunda in gastric fundus.
Heterotopic pancreas, also known as ectopic pancreas, is found mainly in the stomach, duodenum, or jejunum. Pancreatic intraepithelial neoplasia (PanIN) is the non-invasive precursor of pancreatic cancer and gastritis cystica profunda (GCP) is considered a precursor of gastric cancer. As with most putative cancer precursor lesions, the diagnosis and treatment of these lesions has been controversial. A patient with no history of gastric surgery visited our institution for a regular evaluation. Endoscopy showed a 2 x 2 cm sized, protruding mass lesion with overlying normal mucosa on the fundus of stomach. Endoscopic ultrasound (EUS) and computed tomography (CT) led to the possible diagnosis of a gastrointestinal stromal tumor with cystic change. Laparoscopic gastric wedge resection was performed with intra-operative endoscopic guidance. Microscopic examination identified the mass as pancreatic tissue. Furthermore, it demonstrated PanIN, grade 3 (PanIN-3) mixed pancreatobiliary and intestinal type, arising in the heterotopic pancreas and associated with GCP. This report describes a rare case of a PanIN lesion combined with GCP as precursors of precancerous lesions in heterotopic pancreas and stomach.
Department of Surgery, Eulji University Hospital,Daejeon, South Korea; Email: mslee01@eulji.ac.kr.
Moon-Soo
MS
Lee
Byung Sun
BS
Cho
Joo-Seung
JS
Park
Hyun Cheol
HC
Koo
Hyun-Young
HY
Han
Dong-Wook
DW
Kang
D002278:Carcinoma in Situ / Q000473:pathology* / Q000601:surgery; D002828:Choristoma / Q000473:pathology* / Q000601:surgery; D003951:Diagnostic Errors; D019160:Endosonography; D005743:Gastrectomy; D005748:Gastric Fundus / Q000473:pathology* / Q000601:surgery; D005756:Gastritis / Q000473:pathology*; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D011230:Precancerous Conditions / Q000473:pathology* / Q000601:surgery; D011237:Predictive Value of Tests; D013272:Stomach Diseases / Q000473:pathology* / Q000601:surgery; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed