Adenocarcinoma with intraductal papillary mucinous neoplasm arising in a duodenal heterotopic pancreas: a case report
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CASE REPORT
Adenocarcinoma with intraductal papillary mucinous neoplasm arising in a duodenal heterotopic pancreas: a case report Etsuko Hisanaga1,2 · Takaaki Sano3 · Norio Kubo4 · Norihiro Ishii4 · Ken Shirabe4 · Hitoshi Takagi2 · Junko Hirato5 · Hayato Ikota1 Received: 4 March 2020 / Accepted: 27 August 2020 © Japanese Society of Gastroenterology 2020
Abstract A woman in her 70 s was diagnosed with a tumor in her duodenal wall during a routine visit for diabetes. She subsequently underwent subtotal stomach-preserving pancreatoduodenectomy. Histologically, the tumor was present mainly in the duodenal wall, and atypical cystic ducts were seen in the muscularis propria and subserosa. Invasive well-differentiated adenocarcinoma was seen in the duodenal submucosal and mucosal layers. Heterotopic pancreatic tissue was seen within the tumor, and atypical epithelium had proliferated and replaced the cystic ductal epithelium of the heterotopic pancreas. Therefore, adenocarcinoma with intraductal papillary mucinous neoplasm arising in duodenal heterotopic pancreas was the final histopathological diagnosis, which is considered rare. Keywords Duodenum · Heterotopic pancreas · Adenocarcinoma · Intraductal papillary mucinous neoplasm Abbreviations IPMN Intraductal papillary mucinous neoplasm US Ultrasound MRI Magnetic resonance imaging CT Computed tomography EUS Endoscopic ultrasound
* Etsuko Hisanaga e‑hisanaga@gunma‑u.ac.jp 1
Clinical Department of Pathology, Gunma University Hospital, 3‑39‑15 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
2
Department of Internal Medicine, Kusunoki Hospital, 607‑22 Fujioka, Fujioka, Gunma 375‑0024, Japan
3
Department of Diagnostic Pathology, Graduate School of Gunma University, 3‑39‑22 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
4
Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3‑39‑15 Showa‑machi, Maebashi, Gunma 371‑8511, Japan
5
Department of Pathology, Public Tomioka General Hospital, 2073‑1 Tomioka, Tomioka, Gunma 370‑2393, Japan
Introduction Heterotopic pancreatic tissue is found in the stomach, duodenum, and ileum in as many as 0.6–14.0% of autopsies [1]. In very rare cases, carcinoma arising from heterotopic pancreas tissues was reported in 0.7–13.7% of patients with a heterotopic pancreas [2, 3]. We herein report a case of duodenal carcinoma arising in a duodenal heterotopic pancreas, which was histopathologically and immunohistochemically diagnosed in a resected specimen.
Case report A woman in her 70 s was diagnosed with a tumor in her duodenal wall. She had developed diabetes in her 40 s. Four years before presentation, an intraductal papillary mucinous neoplasm (IPMN) of the pancreas body was found by abdominal ultrasound (US) and magnetic resonance imaging (MRI) and was followed up by imaging examinations. The tumor was identified during a routine visit for diabetes because the patient’s glycemic control had suddenly worsened (i.e., 3 months previously, her glycosylated hemoglobin [National Glycohemogl
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