Published online Mar 6, 2023. doi: 10.12998/wjcc.v11.i7.1569
Peer-review started: October 24, 2022
First decision: January 3, 2023
Revised: January 13, 2023
Accepted: February 15, 2023
Article in press: February 15, 2023
Published online: March 6, 2023
A large percentage of patients with ectopic pancreas are asymptomatic. When present, the symptoms are typically non-specific. These lesions are predominantly located in the stomach and benign in nature. Synchronous multiple early gastric cancer (SMEGC) (two or more simultaneous malignant lesions with early gastric cancer) is relatively rare and particularly easy to overlook during endoscopic examination. The prognosis of SMEGC is generally poor. We report a rare case of ectopic pancreas with concomitant SMEGC.
A 74-year-old woman presented with paroxysmal upper abdominal pain. On initial investigations, she tested positive for Helicobacter pylori (H. pylori). She underwent esophagogastroduodenoscopy which revealed a 1.5 cm × 2 cm major lesion at the greater curvature and a 1 cm minor lesion at the lesser curvature of the stomach. On endoscopic ultrasound, the major lesion showed hypoechoic changes, uneven internal echoes and unclear boundaries between some areas and the muscularis propria. Endoscopic submucosal dissection was performed to excise the minor lesion. A laparoscopic resection was chosen for the major lesion. On histopathological examination, the major lesion contained high grade intraepithelial neoplasia with a small focus of cancer. A separate underlying ectopic pancreas was found under this lesion. The minor lesion contained high grade intraepithelial neoplasia. In this case, the patient was diagnosed with SMEGC with concomitant ectopic pancreas in the stomach.
Patients with atrophy, H. pylori, and other risk factors should be carefully investigated to avoid missing other lesions including SMEGC and ectopic pancreas.
Core Tip: This case demonstrates that ectopic pancreas can be found in combination with synchronous multiple early gastric cancer (SMEGC). Careful endoscopic inspection of the mucosal surface is mandatory to avoid overlooking SMEGC. It is important to be mindful of the possible presence of ectopic pancreas, perform an in-depth evaluation and select the correct surgical option for excision or resection. This case also reminds us that in the presence of atrophy, intestinal metaplasia and Helicobacter pylori infection combined with ectopic pancreas, it is necessary to evaluate the stomach very carefully, so as not to miss the diagnosis of early gastric cancer.