Murabayashi Toji, Kawaguchi Shinya, Okuda Naoko, Oyamada Jun, Yabana Tadashi
Department of Gastroenterology, Ise Red Cross Hospital, Ise, Japan.
Department of Pathology, Ise Red Cross Hospital, Ise, Japan.
Case Rep Gastroenterol. 2016 Jun 27;10(2):308-14. doi: 10.1159/000447294. eCollection 2016 May-Aug.
We report the first case of early gastric cancer just above a heterotopic pancreas for which the differential diagnosis was carcinoma arising from heterotopic pancreas. Routine upper gastrointestinal endoscopy in an 83-year-old man with sigmoid colon cancer revealed a gastric cancer in the lesser curvature of the antrum. Endoscopic ultrasonography (EUS) for evaluating the depth of tumor invasion revealed a hypoechoic mass in the submucosal layer. The depth of tumor invasion was diagnosed as muscularis propria. Distal gastrectomy and sigmoidectomy were performed. Histologically, the resected specimen of the stomach unexpectedly revealed a heterotopic pancreas just below the gastric cancer. They were not linked, and the heterotopic pancreas had no dysplasia. The gastric cancer had slightly invaded the submucosa. The hypoechoic mass on EUS was not the invasive tumor but the heterotopic pancreas. The preoperative staging of the gastric cancer on EUS was confounded by the presence of the heterotopic pancreas just below the gastric cancer.
我们报告了首例位于异位胰腺上方的早期胃癌病例，其鉴别诊断为起源于异位胰腺的癌。一名83岁患有乙状结肠癌的男性进行常规上消化道内镜检查时，发现胃窦小弯处有胃癌。用于评估肿瘤浸润深度的内镜超声检查（EUS）显示黏膜下层有低回声肿块。肿瘤浸润深度诊断为固有肌层。行远端胃切除术和乙状结肠切除术。组织学检查显示，切除的胃标本意外地发现胃癌下方有一个异位胰腺。它们不相连，且异位胰腺无发育异常。胃癌已轻微侵犯黏膜下层。EUS上的低回声肿块不是浸润性肿瘤，而是异位胰腺。胃癌下方存在异位胰腺，使EUS对胃癌的术前分期产生混淆。
