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Abstract
A 74-year-old man presented with intestinal obstruction. CT (computed tomography) revealed a 25-mm mass in the proximal jejunum. Double-balloon endoscopy (DBE) identified a smooth, asymmetrically localized mass with oozing and luminal stenosis covered with the mucosa of swollen villi. Small bowel radiography demonstrated jejunal obstruction. Histopathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma arising from ectopic pancreatic tissue of Heinrich type I. Our case suggests that cancer arising from ectopic pancreas should be considered as a candidate diagnosis of a submucosal tumor in the jejunum.
Highlights
Ectopic pancreas is a developmental anomaly, which is characterized by the existence of pancreatic tissue in the gastrointestinal tract
It should be noted that the pancreatic tissue possibly shows malignant transformation, the incidence ranges from 0.7 to 1.8% [10] among the autopsy cases
It still remains obscure whether ectopic pancreas has a higher burden for cancer development when compared to the pancreas [11]
Summary
Ectopic pancreas is a developmental anomaly, which is characterized by the existence of pancreatic tissue in the gastrointestinal tract It occurs a subepithelial lesion (SEL), in the stomach and in the small intestine [1, 2]. Because abdominal CT revealed small bowel dilation, he was admitted with a diagnosis of intestinal obstruction His symptoms transiently relieved, he again complained of vomiting after he started the oral intake. Histopathological examination of the resected specimen revealed pancreatic tissue in the submucosa, including pancreatic ducts, acinar cells, and islets of Langerhans (Fig. 4b), leading to a diagnosis of ectopic pancreas of Heinrich type I. The center of the tumor was covered by villous hyperplasia with the infiltration of predominant lymphocytes in the lamina propria (Fig. 4d) Based on these findings, the tumor was diagnosed as a cancer arising from ectopic pancreas in the jejunum. The patient recovered uneventfully after the surgery, and he has been doing well under an adjuvant chemotherapy with S-1 at a daily dose of 120 mg in accordance with the clinical practice guideline for pancreatic cancer [6]
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