A CASE OF ADENOCARCINOMA ARISING FROM AN ECTOPIC PANCREAS OF THE STOMACH WITH ABNORMALLY HIGH CA19-9 LEVELS

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  • 術前ＣＡ１９‐９高値を呈した胃異所性膵原発腺癌の１例

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Abstract

A 72-year-old woman was admitted to our hospital because of abdominal fullness, nausea and vomiting lasting for three months. Upper gastrointestinal fiberscopy suggested pyloric stenosis and no mucosal irregularity. Abdominal computed tomographic scan showed that a tumor had displaced the gastric wall into the stomach cavity. On the blood examination, the carbohydrate antigen 19-9 (CA19-9) level was markedly elevated to 1,333 U/ml. Preoperative histopathological examination failed to provide definitive diagnosis, and then distal gastrectomy was performed. After the gastric tumor was diagnosed as well differentiated adenocarcinoma by the intraoperative rapid diagnosis, D2 lymph node dissection was additionally performed. Postoperative histopathological findings showed that the main location of the tumor was in the submucosa of the stomach wall and the tumor was unexposed to the mucosal surface. Adenocarcinoma was present adjacent to an ectopic pancreas with pancreatic ducts in the muscularis propria of the stomach (Heinrich type III). Immunohistochemical study for CA19-9 revealed aberrant pancreas transformed to adenocarcinoma and was helpful for making diagnosis of adenocarcinoma arising from an ectopic pancreas of the stomach. It is rarely seen that an ectopic pancreas of the stomach gives rise to cancer. We report a case of adenocarcinoma arising from an ectopic pancreas with a remarkably high CA19-9 level before surgery.

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