Zhao Zhen-Ya, Lai Yue-Xing, Xu Ping
Department of Gastroenterology, Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine (Preparatory Stage), Shanghai 201600, China.
World J Clin Cases. 2023 Mar 6;11(7):1569-1575. doi: 10.12998/wjcc.v11.i7.1569.
A large percentage of patients with ectopic pancreas are asymptomatic. When present, the symptoms are typically non-specific. These lesions are predominantly located in the stomach and benign in nature. Synchronous multiple early gastric cancer (SMEGC) (two or more simultaneous malignant lesions with early gastric cancer) is relatively rare and particularly easy to overlook during endoscopic examination. The prognosis of SMEGC is generally poor. We report a rare case of ectopic pancreas with concomitant SMEGC.
A 74-year-old woman presented with paroxysmal upper abdominal pain. On initial investigations, she tested positive for (). She underwent esophagogastroduodenoscopy which revealed a 1.5 cm × 2 cm major lesion at the greater curvature and a 1 cm minor lesion at the lesser curvature of the stomach. On endoscopic ultrasound, the major lesion showed hypoechoic changes, uneven internal echoes and unclear boundaries between some areas and the muscularis propria. Endoscopic submucosal dissection was performed to excise the minor lesion. A laparoscopic resection was chosen for the major lesion. On histopathological examination, the major lesion contained high grade intraepithelial neoplasia with a small focus of cancer. A separate underlying ectopic pancreas was found under this lesion. The minor lesion contained high grade intraepithelial neoplasia. In this case, the patient was diagnosed with SMEGC with concomitant ectopic pancreas in the stomach.
Patients with atrophy, , and other risk factors should be carefully investigated to avoid missing other lesions including SMEGC and ectopic pancreas.
大部分异位胰腺患者无症状。有症状时，症状通常不具特异性。这些病变主要位于胃，本质上是良性的。同步多发早期胃癌（SMEGC，即两个或更多同时存在的早期胃癌恶性病变）相对少见，在内镜检查时尤其容易被忽视。SMEGC的预后通常较差。我们报告一例罕见的异位胰腺合并SMEGC病例。
一名74岁女性因阵发性上腹痛就诊。初步检查时，她（此处原文缺失相关检查结果）检测呈阳性。她接受了食管胃十二指肠镜检查，结果显示胃大弯处有一个1.5厘米×2厘米的主要病变，胃小弯处有一个1厘米的次要病变。在内镜超声检查中，主要病变显示低回声改变、内部回声不均匀，部分区域与固有肌层之间边界不清。对次要病变进行了内镜黏膜下剥离术切除。对主要病变选择了腹腔镜切除术。组织病理学检查显示，主要病变包含高级别上皮内瘤变并伴有小灶癌。在该病变下方发现了一个单独的潜在异位胰腺。次要病变包含高级别上皮内瘤变。在本病例中，患者被诊断为SMEGC合并胃内异位胰腺。
对于有萎缩、（此处原文缺失相关内容）及其他危险因素的患者，应仔细检查，以避免漏诊包括SMEGC和异位胰腺在内的其他病变。
