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Adenocarcinoma arising in gastric heterotopic pancreas: a case report.

Song DE, Kwon Y, Kim KR, Oh ST, Kim JS - J. Korean Med. Sci. (2004)

Bottom Line: A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare.Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures.The follow-up course was uneventful 5 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.

ABSTRACT
A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. Esophagogastroduodenoscopy revealed a submucosal tumor with an irregular central umbilication in the gastric antrum. A wedge resection specimen demonstrated a submucosal oligolocular cystic mass (1.7 x 1.4 x 1.2 cm) with a solid portion. Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures. The adenocarcinoma components in the solid area infiltrated the proper muscle and the overlying mucosa of the stomach. The transitional area between the benign ductal structures and the adenocarcinoma component was found. The follow-up course was uneventful 5 months postoperatively.

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Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40).
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Figure 6: Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40).

Mentions: Grossly, the submucosal mass (2×1.7×1.2 cm) was composed of a whitish tan oligolocular cystic portion and a yellowish tan solid granular portion with an intact overlying mucosa. Microscopically, the cystic portion was lined by a single layer of flat, cuboidal epithelium and surrounded by smooth muscle layers (Fig. 3, arrow and Fig. 4A). Periductal glandular structures were focally identified without islet cells (Fig. 4B). In the solid area, the adenocarcinoma components forming well-formed tubules (Fig. 5) infiltrated the underlying proper muscle layer and the overlying mucosa of the stomach. Lymphovascular tumor emboli were frequently seen in areas adjacent to the adenocarcinoma components. A dysplastic change was found in the epithelium of the cystic portion of the heterotopic pancreas, adjacent to the invasive adenocarcinoma (Fig. 5). The neoplastic cells and the heterotopic pancreas tissue showed diffusely strong positivity for cytokeratin 7 (CK7+, 1:200, DAKO, Denmark) and negativity for cytokeratin 20 (CK20-, 1:200, DAKO, Denmark) by immunohistochemical stainings (Fig. 6). The overlying gastric mucosa showed CK7+ only in mucous neck cells and CK20+ in foveolar epithelial cells. The subsequent distal gastrectomy specimen revealed no residual tumor. Lymph node metastasis was not identified. The follow-up course was uneventful 5 months postoperatively.


Adenocarcinoma arising in gastric heterotopic pancreas: a case report.

Song DE, Kwon Y, Kim KR, Oh ST, Kim JS - J. Korean Med. Sci. (2004)

Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2822253&req=5

Figure 6: Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40).
Mentions: Grossly, the submucosal mass (2×1.7×1.2 cm) was composed of a whitish tan oligolocular cystic portion and a yellowish tan solid granular portion with an intact overlying mucosa. Microscopically, the cystic portion was lined by a single layer of flat, cuboidal epithelium and surrounded by smooth muscle layers (Fig. 3, arrow and Fig. 4A). Periductal glandular structures were focally identified without islet cells (Fig. 4B). In the solid area, the adenocarcinoma components forming well-formed tubules (Fig. 5) infiltrated the underlying proper muscle layer and the overlying mucosa of the stomach. Lymphovascular tumor emboli were frequently seen in areas adjacent to the adenocarcinoma components. A dysplastic change was found in the epithelium of the cystic portion of the heterotopic pancreas, adjacent to the invasive adenocarcinoma (Fig. 5). The neoplastic cells and the heterotopic pancreas tissue showed diffusely strong positivity for cytokeratin 7 (CK7+, 1:200, DAKO, Denmark) and negativity for cytokeratin 20 (CK20-, 1:200, DAKO, Denmark) by immunohistochemical stainings (Fig. 6). The overlying gastric mucosa showed CK7+ only in mucous neck cells and CK20+ in foveolar epithelial cells. The subsequent distal gastrectomy specimen revealed no residual tumor. Lymph node metastasis was not identified. The follow-up course was uneventful 5 months postoperatively.

Bottom Line: A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare.Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures.The follow-up course was uneventful 5 months postoperatively.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea.

ABSTRACT
A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally and its malignant transformation is extremely rare. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. Esophagogastroduodenoscopy revealed a submucosal tumor with an irregular central umbilication in the gastric antrum. A wedge resection specimen demonstrated a submucosal oligolocular cystic mass (1.7 x 1.4 x 1.2 cm) with a solid portion. Microscopically, the cystic portion was composed of dilated pancreaticobiliary type ducts with adjacent small foci of periductal glandular structures. The adenocarcinoma components in the solid area infiltrated the proper muscle and the overlying mucosa of the stomach. The transitional area between the benign ductal structures and the adenocarcinoma component was found. The follow-up course was uneventful 5 months postoperatively.

Show MeSH
Related in: MedlinePlus