Abstract
We report a case of adenocarcinoma arising in a focus of heterotopic pancreas, occurring in the stomach of a 52βyearβold man. The patient presented with gastric outlet obstruction. Radiographic studies revealed thickening of the gastric wall, but endoscopy failed to reveal a mucosal abnormality. A 50% distal gastrectomy was performed, along with vagotomy. Microscopic examination revealed extensive involvement of the muscularis propria of the distal stomach by heterotopic pancreas. The ectopic pancreas had a microscopic appearance consistent with Heinrich's class III, in which the majority of the heterotopic pancreas was characterized by cystically dilated duct structures. Occasional islets were present. Intimately associated with the cystically dilated ducts was a prominent number of small infiltrating ducts lined by columnar or cuboidal cells with enlarged hyperchromatic nuclei containing prominent nucleoli. These were consistent with a wellβdifferentiated invasive adenocarcinoma. Despite multiple sectioning, no connection between the adenocarcinoma and the overlying gastric mucosa was seen. Adenocarcinoma arising within ectopic pancreas is a rare occurrence with fewer than 30 wellβdocumented cases reported in the world literature to our knowledge. J. Surg. Oncol. 2004;87:53β57. Β© 2004 WileyβLiss, Inc.