Iwahashi Shoko, Nishi Masaaki, Yoshimoto Toshiaki, Kashihara Hideya, Takasu Chie, Tokunaga Takuya, Miyatani Tomohiko, Higashijima Jun, Yoshikawa Kozo, Wada Yuma, Bando Yoshimi, Shimada Mitsuo
Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan.
Department of Division of Pathology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
Surg Case Rep. 2019 Jul 10;5(1):110. doi: 10.1186/s40792-019-0669-7.
Heterotopic pancreas (HP) is a rare disease commonly found incidentally on imaging studies, at endoscopy or at autopsy and can be associated with abdominal pain, vomiting, heart burn, gastric outlet obstruction, and even dysphagia in very rare cases. Heinrich's classified HP into three groups, types1-3, with Heinrich's type 3 HP the rarest and difficult to diagnose properly because it has only pancreatic ducts but has no islet and acini. The aim of this study is to report a case of gastric outlet obstruction caused by type 3 HP with gastroduodenal invagination with reference to the literature and diagnosed finally by immuno-histochemical analysis.
The case presented is a 40-year-old male presenting with vomiting and abdominal pain. Computed tomography (CT) revealed a cystic mass in the upper abdomen and he was referred to the Tokushima University. Gastric fiber showed that the pedunculated mass originated from the stomach. An open distal gastrectomy was performed. Pathologically, there was small glands proliferation in the sub-mucosal (SM) layer which was membrane and cytoplasm (MUC)1 positive and muscle proliferation.
This finding revealed the tumor as HP. Postoperative course was uneventful and the patient was discharged 12 days after surgery. The patient has remained well 12 months after surgery.
HP should be considered in the differential diagnosis of SM tumors with gastroduodenal invagination even if this is a rare symptom.
异位胰腺（HP）是一种罕见疾病，通常在影像学检查、内镜检查或尸检时偶然发现，可能与腹痛、呕吐、烧心、胃出口梗阻有关，在极少数情况下甚至会导致吞咽困难。海因里希将HP分为1-3型，其中海因里希3型HP最为罕见且难以正确诊断，因为它只有胰管，但没有胰岛和腺泡。本研究的目的是参考文献报告一例由3型HP伴胃十二指肠套叠引起胃出口梗阻的病例，并最终通过免疫组织化学分析确诊。
该病例为一名40岁男性，表现为呕吐和腹痛。计算机断层扫描（CT）显示上腹部有一个囊性肿块，他被转诊至德岛大学。胃镜检查显示带蒂肿块起源于胃。进行了开放性远端胃切除术。病理检查显示黏膜下层（SM）有小腺体增生，其膜和细胞质（MUC）1呈阳性，并有肌肉增生。
这一发现表明该肿瘤为HP。术后病程顺利，患者术后12天出院。术后12个月患者情况良好。
即使胃十二指肠套叠是一种罕见症状，在鉴别诊断伴有胃十二指肠套叠的SM肿瘤时也应考虑HP。
