Primary adenocarcinoma from a gastric heterotopic pancreas: A case report

Table 1 Clinicopathological characteristics of heterotopic pancreatic adenocarcinomas (n = 21)

Ref.	Sex, age	Location	Morphology	Clinical presentation	Tumor markers	Diagnostic methods	Histology	Heinrich type	Initial diagnosis	Outcome	Adjuvant therapy
Matsuki et al[5], 2005	Female, 58 years old	Gastric antrum	SET with stenosis	Gastric outlet obstruction (vomiting)	CEA, CA19-9: Normal	EUS: Diffuse wall thickening in prepyloric region	Adenocarcinoma	II	Suspected malignancy	No recurrence (1.5 years)	None
Fujita et al[13], 2008	Female, 64 years old	Jejunum	Umbilicated mass	Abdominal distension/epigastric pain	Not tested	DBE: Umbilicated mass (intraoperative confirmation)	Adenocarcinoma	I	Jejunal cancer	Death (5 months after surgery; metastasis)	Gemcitabine
Bini et al[14], 2010	Male, 56 years old	Duodenum (D1)	SET	Vomiting	CA19-9/CA125/AFP: Normal limits	EGD + EUS: Submucosal hypoechoic lesion and biopsies were performed	Adenocarcinoma	I	Adenocarcinoma of unknown origin	Not reported	Referred for chemotherapy
Song et al[15], 2012	Male, 74 years old	Jejunum	Perforating tumor	Acute abdominal pain, stool problems	CA19-9 elevated	Not performed	Adenocarcinoma	II	Peritonitis from perforation of sigmoid colon cancer	Not reported	Not reported
Stock et al[16], 2011	Female, 79 years old	Duodenum (D4)	Not described	Early satiety (2 years)	Not tested	EGD: Duodenal mass	Adenocarcinoma	I	Not reported	Not reported	Adjuvant chemotherapy
Fukumori et al[9], 2011	Female, 76 years old	Gastric pylorus	SET	Not reported	CA19-9: 177.5 to 279.5 U/mL	EUS: SMT	Adenocarcinoma	II	GIST	Not reported	Not reported
Okamoto et al[17], 2012	Female, 75 years old	Stomach	SET	Epigastric pain	CEA, CA19-9 elevated	EGD: Subepithelial tumor	Adenocarcinoma	I	SET	No recurrence (11 years)	Not reported
Kinoshita et al[18], 2012	Female, 62 years old	Duodenum	Stenotic	Vomiting/epigastric pain	CEA, CA19-9 elevated	EGD: Gastric outlet obstruction	Adenocarcinoma	I	Advanced gastric cancer	No recurrence (12 months)	Not reported
Ginori et al[19], 2013	Male, 86 years old	Duodenal bulb	Stenotic	Abdominal pain/dyspepsia for 2 months	Not tested	Not performed	Adenocarcinoma	I	Acute cholecystitis	Gastrectomy, alive with metastasis	Not reported
Endo et al[4], 2014	Male, 75 years old	Duodenum	Stenotic	Epigastric pain/tarry stools	CEA, CA19-9 increased	EUS-FNA: SMT	Adenocarcinoma	I	Duodenal cancer	No recurrence (5 years)	Not reported
Endo et al[4], 2014	Male, 73 years old	Stomach	SET	Epigastric pain	CEA, CA19-9: Normal	EUS: 4th layer hypoechoic mass (EMR-C + biopsy)	Adenocarcinoma	I	Gastric cancer	Lymph node metastasis (2 years follow-up)	Not reported
Fukino et al[12], 2015	Male, 62 years old	Duodenum (D3)	SET	6 kg weight loss in (4 months)	CEA: Normal limits, CA19-9/DUPAN-2/SPan-1 elevated	Duodenal fibroscopy: SMT	Adenocarcinoma	IV	Duodenal carcinoma	Death (33 months after surgery)	S-1 + cisplatin to radiation + GEM (recurrence)
Mehra et al[10], 2015	Male, 51 years old	Duodenum (D3)	Not described	Abdominal pain/nausea	Not tested	EGD: Mucosal growth in duodenum	Adenocarcinoma	II	Not reported	No recurrence	Not reported
Hisanaga et al[20], 2020	Female, 70 years old	Duodenum	Rough, protuberant lesion	Incidental (diabetes)	Not tested	EUS: Multilocular protuberant lesion	Adenocarcinoma	I	Pancreatic carcinoma	No recurrence (10 months)	Not reported
Jung et al[21], 2020	Male, 75 years old	Stomach	Submucosal lesion with gastric outlet obstruction	Dyspepsia, nausea/3 kg weight loss within 1 month	CEA, CA19-9 increased	GIE and EUS (2008) hypoechoic lesion involving the 2nd/3rd layers; GIE (2018) tumor increased	Adenocarcinoma	Not specified	Gastric outlet obstruction	Follow-up < 6 months	Capecitabine + oxaliplatin
Oto et al[22], 2021	Male, 37 years old	Stomach	Pylorus stenosis	Nausea/upper abdominal pain	Not tested	EGD: Pyloric stenosis	Adenocarcinoma	Not specified	Not reported	Not reported	Not reported
Hirokawa et al[11], 2021	Female, 65 years old	Duodenum (D1)	Ulcer formation	Epigastric discomfort	CEA, CA125 elevated	EGD: Ulcerated tumor (biopsy-confirmed)	Adenocarcinoma	Not specified	Unresectable duodenal cancer	Progression (24 months)	Trastuzumab (HER2+) pre-operation + chemo, post-operation
Qian et al[2], 2023	Female, 59 years old	Stomach	Stenotic	Abdominal discomfort/acid regurgitation	Not tested	EGD: Pyloric area congestion and swelling; pyloric canal stenosis	Adenocarcinoma	III	Pyloric obstruction and adenocarcinoma	Recurrence and metastasis (1-year post-op)	Gemcitabine + tigecycline
Woo et al[6], 2023	Male, 65 years old	Duodenal bulb	Stricture	Dyspepsia/vomiting	Not tested	EGD: Duodenal stricture	Adenocarcinoma	III	Benign stricture	No recurrence (24 months)	FOLFIRINOX
Yamaoka et al[8], 2015	Female, 65 years old	Jejunum	SET	Incidental finding	CA19-9: 635 U/mL, CEA: 22 ng/mL	DBE: SMT	Adenocarcinoma	II	Peritoneal metastasis from colon cancer	Peritoneal recurrence (9 months)	S-1 to gemcitabine + nab-paclitaxel
Ji et al[7], 2024	Female, 75 years old	Stomach (antrum)	SMT	Health screening	CA19-9 elevated	EGD: Submucosal bulge	Adenocarcinoma	Not specified	Primary pyloric malignancy	Not reported	Not reported

Adopted from Cazacu et al[1]. SET: Subepithelial tumor; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; EUS: Endoscopic ultrasound; DBE: Double-balloon enteroscopy; D1/D3/D4: Duodenal 1^st/3^rd/4^th portion; CA125: Carbohydrate antigen 125; AFP: Alpha-fetoprotein; EGD: Esophagogastroduodenoscopy; GIST: Gastrointestinal stromal tumor; EUS-FNA: Endoscopic ultrasound-guided fine needle aspiration; EMR-C: Endoscopic mucosal resection with cap; GEM: Gemcitabine; HER2+: Human epidermal growth factor receptor 2-positive; S-1: Tegafur/gimeracil/oteracil; SMT: Submucosal tumor; GIE: Gastrointestinal endoscopy.