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Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report

BACKGROUND: Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We...

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Autores principales: Minami, Teruya, Terada, Takuro, Mitsui, Takeshi, Nakanuma, Yasuni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303251/
https://www.ncbi.nlm.nih.gov/pubmed/32556717
http://dx.doi.org/10.1186/s40792-020-00903-z
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author Minami, Teruya
Terada, Takuro
Mitsui, Takeshi
Nakanuma, Yasuni
author_facet Minami, Teruya
Terada, Takuro
Mitsui, Takeshi
Nakanuma, Yasuni
author_sort Minami, Teruya
collection PubMed
description BACKGROUND: Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum. CASE PRESENTATION: A 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumor-specific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing. CONCLUSIONS: HP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended.
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spelling pubmed-73032512020-06-22 Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report Minami, Teruya Terada, Takuro Mitsui, Takeshi Nakanuma, Yasuni Surg Case Rep Case Report BACKGROUND: Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum. CASE PRESENTATION: A 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumor-specific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing. CONCLUSIONS: HP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended. Springer Berlin Heidelberg 2020-06-18 /pmc/articles/PMC7303251/ /pubmed/32556717 http://dx.doi.org/10.1186/s40792-020-00903-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Minami, Teruya
Terada, Takuro
Mitsui, Takeshi
Nakanuma, Yasuni
Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title_full Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title_fullStr Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title_full_unstemmed Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title_short Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
title_sort adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303251/
https://www.ncbi.nlm.nih.gov/pubmed/32556717
http://dx.doi.org/10.1186/s40792-020-00903-z
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