Kafaru Musili, Sharma Bharti, Meyer M Maisy, Liu Shaojun, Blue Robert, Agriantonis George, Whittington Jennifer, Shafaee Zahra
Department of Surgery, NYC Health + Hospitals/Elmhurst, Queens, NY, USA.
Department of Surgery, Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA.
Radiol Case Rep. 2025 Jul 24;20(10):5090-5094. doi: 10.1016/j.radcr.2025.06.057. eCollection 2025 Oct.
Heterotopic pancreas is a rare, benign condition characterized by the presence of pancreatic tissue outside its normal anatomical location, and its association with malignancy is extremely rare. Gastritis cystica profunda (GCP), also a rare condition, is the cystic formation of gastric glands in the stomach submucosa and/or muscularis propria. We present the case of a 65-year-old male with who presented to the emergency department (ED) with 6 day history of worsening epigastric pain and nonbloody emesis. Computed tomography (CT) revealed gastric outlet obstruction (GOO) caused multiloculated cystic mass in the gastric antrum. Endoscopic evaluation, including esophagogastroduodenoscopy with endoscopic ultrasonography and fine needle aspiration (EGD/EUS-FNA), identified multiple cystic masses in the pylorus and duodenal bulb, which were thought to be GCP. Cytology from the EUS-FNA was benign. Carcinoembryonic antigen (CEA) of aspirated fluid was elevated to 709. The patient underwent endoscopic-guided stent placement to relieve gastric outlet obstruction and subsequent robotic partial gastrectomy. Pathological examination revealed well-differentiated invasive adenocarcinoma arising from ectopic pancreatic tissue. Postoperative imaging of the pancreas revealed no abnormalities. This case underscores the diagnostic challenges in identifying adenocarcinoma arising from heterotopic pancreas, initially misdiagnosed as GCP, and highlights the importance of considering rare causes of gastric masses in clinical practice.
异位胰腺是一种罕见的良性疾病，其特征是胰腺组织存在于正常解剖位置之外，与恶性肿瘤的关联极为罕见。胃深部囊肿性胃炎（GCP）也是一种罕见疾病，是胃黏膜下层和/或固有肌层中胃腺的囊性形成。我们报告了一例65岁男性患者，他因上腹部疼痛加重和非血性呕吐6天而就诊于急诊科。计算机断层扫描（CT）显示胃窦部多房囊性肿块导致胃出口梗阻（GOO）。内镜评估，包括食管胃十二指肠镜检查、内镜超声检查和细针穿刺活检（EGD/EUS-FNA），在幽门和十二指肠球部发现多个囊性肿块，考虑为GCP。EUS-FNA的细胞学检查结果为良性。吸出液的癌胚抗原（CEA）升高至709。患者接受了内镜引导下支架置入术以缓解胃出口梗阻，随后进行了机器人辅助部分胃切除术。病理检查显示起源于异位胰腺组织的高分化浸润性腺癌。术后胰腺影像学检查未发现异常。该病例强调了识别起源于异位胰腺的腺癌（最初误诊为GCP）的诊断挑战，并突出了在临床实践中考虑胃肿块罕见病因的重要性。
