Papaziogas Basilios, Koutelidakis Ioannis, Tsiaousis Panagiotis, Panagiotopoulou Konstantina, Paraskevas George, Argiriadou Helena, Atmatzidis Stefanos, Atmatzidis Konstantinos
2nd Surgical Clinic, Aristotle's University of Thessaloniki Medical School, "G, Gennimatas" Hospital, Ethnikis Aminis 41, 546 35 Thessaloniki, Greece.
Cases J. 2008 Oct 18;1(1):249. doi: 10.1186/1757-1626-1-249.
The development of pancreatic tissue outside the confines of the main gland, without anatomic or vascular connections between them, is a congenital abnormality referred to as heterotopic pancreas. A heterotopic pancreas in the gastrointestinal tract is usually discovered incidentally and the risk of its malignant transformation is extremely low. In this study, we describe the first case of endoepithelial carcinoma arising in a gastric heterotopic pancreas of a 56-year old woman in Greece. She presented with epigastric pain, periodic nausea and vomiting. Esophagogastroduodenoscopy revealed an ulcerated lesion in the gastric antrum, biopsies of which showed intense epithelial dysplasia with incipient malignant degeneration. The pathology report of the distal gastrectomy specimen demonstrated a 2 cm in diameter ulcerative mass in the gastric antrum. Microscopically, an endoepithelial (in situ) carcinoma of the gastric antrum was determined, which in places turned into an microinvasive endomucosal adenocarcinoma. It also incidentally demonstrated heterotopic pancreatic ducts, detected within the mucosa to the muscularis propria of the same region of the stomach, in which an endoepithelial (in situ) carcinoma was evolving. The follow-up course was uneventful 6 months postoperatively.
胰腺组织在主腺体范围之外发育，且与主腺体之间无解剖学或血管连接，这种先天性异常被称为异位胰腺。胃肠道中的异位胰腺通常是偶然发现的，其发生恶性转化的风险极低。在本研究中，我们描述了希腊一名56岁女性胃异位胰腺中发生的首例内皮癌。她表现为上腹部疼痛、周期性恶心和呕吐。食管胃十二指肠镜检查发现胃窦有一个溃疡病变，活检显示有严重的上皮发育异常并伴有早期恶性变。远端胃切除标本的病理报告显示胃窦有一个直径2厘米的溃疡性肿块。显微镜下，确定为胃窦内皮（原位）癌，部分区域已转变为微浸润性黏膜内腺癌。同时还偶然发现了异位胰管，在胃同一区域的黏膜至固有肌层内检测到，其中有一个内皮（原位）癌正在发展。术后6个月随访过程顺利。
