title: "Ductal adenocarcinoma in anular pancreas".
abstract: BACKGROUND
  The annular pancreas is a congenital anomaly in which pancreatic tissue partially or completely surrounds the second portion of the duodenum. Its often located above of papilla of Vater (85%), rarely below (15%). This pancreatic tissue is often easily dissociable to the duodenum but there is same cases where it the tissue is into the muscolaris wall of the duodenum.
  
  
  METHODS
  We describe three case of annular pancreas hospitalized in our facility between January 2004 and January 2009. There were 2 male 65 and 69 years old respectively and 1 female of 60 years old, presented complaining of repeated episodes of mild epigastric pain. Laboratory tests (including tumor markers), a direct abdomen X-ray with enema, EGDS and total body CT scan were performed to study to better define the diagnosis. EUS showed the presence of tissue infiltrating the muscle layer all around the first part of duodenum. Biopsies performed found the presence of pancreatic tissue with focal areas of adenocarcinoma. Subtotal gastrectomy with Roux was performed. The histological examinations shows an annular pancreas of D1 with multiple focal area of adenocarcinoma. (T1aN0M0).
  
  
  RESULTS
  We performed a follow up at 5 years. One patients died after 36 months for cardiovascular hit. Two patients, one male and one female, was 5-years disease-free.
  
  
  CONCLUSIONS
  Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy. Electronic address: g.benassa@unina.it.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Benassai
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Perrotta
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Ermenegildo
authors.initials: E
authors.lastname: Furino
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: De Werra
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Aloia
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Del Giudice
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Vigliotti
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Limite
authors.affiliation: Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Quarto
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis; D000368:Aged; D044584:Carcinoma, Ductal / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010179:Pancreas / Q000002:abnormalities*; D010182:Pancreatic Diseases / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed
keywords: Anular pancreas; Ectopic pancreas; Gastric cancer