Skip to main content
Log in

Intraductal papillary mucinous neoplasm originating from a jejunal heterotopic pancreas: report of a case

  • Case Report
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

We report a rare case of an intraductal papillary mucinous neoplasm (IPMN) originating from a jejunal heterotopic pancreas, found incidentally during surgery. A 75-year-old woman was referred to our department for surgical treatment of an abdominal aortic aneurysm (AAA) and a concurrent oropharyngeal tumor. During surgery to correct the AAA, we found a jejunal tumor incidentally and performed partial resection of the jejunum. Microscopically, the jejunal tumor showed dilated ducts containing intraluminal papillae lined with mucinous epithelium with low-grade cytological and architectural atypia within the pancreatic tissue. Immunohistochemical staining revealed MUC1 (−), MUC2 (−), MUC5AC (+), and MUC6 (−) proteins. To the best of our knowledge, only six cases of IPMN originating from a heterotopic pancreas have been reported in English, and this is the first report of an IPMN originating from a jejunal heterotopic pancreas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

References

  1. Dolan RV, ReMine WH, Dockerty MB. The fate of heterotopic pancreatic tissue. A study of 212 cases. Arch Surg. 1974;109:762–5.

    Article  CAS  PubMed  Google Scholar 

  2. Lai EC, Tompkins RK. Heterotopic pancreas. Review of a 26 year experience. Am J Surg. 1986;151:697–700.

    Article  CAS  PubMed  Google Scholar 

  3. Cates JM, Williams TL, Suriawinata AA. Intraductal papillary mucinous adenoma that arises from pancreatic heterotopia within a meckel diverticulum. Arch Pathol Lab Med. 2005;129:67–9.

    Google Scholar 

  4. Park HS, Jang KY, Kim YK, Yu HC, Cho BH, Moon WS. Cystic lesion mimicking intraductal papillary mucinous tumor arising in heterotopic pancreas of the stomach and synchronous intraductal papillary mucinous adenocarcinoma of the pancreas. Int J Surg Pathol. 2008;16:324–8.

    Article  PubMed  Google Scholar 

  5. Patel N, Berzin T. Intraductal papillary mucinous neoplasm arising in a heterotopic pancreas: a case report. Am J Gastroenterol. 2010;105:2513–4.

    Article  PubMed  Google Scholar 

  6. Phillips J, Katz A, Zopolsky P. Intraductal papillary mucinous neoplasm in an ectopic pancreas located in the gastric wall. Gastrointest Endosc. 2006;64:814–5.

    Article  PubMed  Google Scholar 

  7. Rosok BI, Rosseland AR, Grzyb K, Mathisen O, Edwin B. Laparoscopic resection of an intraductal papillary mucinous carcinoma in ectopic pancreatic tissue. J Laparoendosc Adv Surg Tech A. 2008;18:723–5.

    Article  PubMed  Google Scholar 

  8. Tsapralis D, Charalabopoulos A, Karamitopoulou E, Schizas D, Charalabopoulos K, Liakakos T, et al. Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature. Diagn Pathol. 2010;5:4.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Heinrich H. Ein Beirag zur Historogie des sogen. akzessorischen pankreas (in Germany). Virchows Arch f Pathol Anat Bd. 1909;198:392–401.

  10. Biswas A, Husain EA, Feakins RM, Abraham AT. Heterotopic pancreas mimicking cholangiocarcinoma. Case report and literature review. JOP 2007;8:28–34.

    PubMed  Google Scholar 

  11. Emerson L, Layfield LJ, Rohr LR, Dayton MT. Adenocarcinoma arising in association with gastric heterotopic pancreas: a case report and review of the literature. J Surg Oncol. 2004;87:53–7.

    Article  PubMed  Google Scholar 

  12. Hamabe A, Ueshima S, Akamatsu H, Tori M, Omori T, Urakawa S, et al. Infected pancreatic necrosis occurring in a jejunal aberrant pancreas: report of a case. Surg Today. 2012. doi:10.1007/s00595-011-0104-6.

    PubMed  Google Scholar 

  13. Matsuki M, Gouda Y, Ando T, Matsuoka H, Morita T, Uchida N, et al. Adenocarcinoma arising from aberrant pancreas in the stomach. J Gastroenterol. 2005;40:652–6.

    Article  PubMed  Google Scholar 

  14. Mizuno Y, Sumi Y, Nachi S, Ito Y, Marui T, Saji S, et al. Acinar cell carcinoma arising from an ectopic pancreas. Surg Today. 2007;37:704–7.

    Article  PubMed  Google Scholar 

  15. Ohashi K, Murakami Y, Maruyama M, Takekoshi T, Ohta H, Ohashi I. Four cases of mucous-secreting pancreatic cancer (in Japanese). Progress of digestive disease. 1982;20:348–51.

    Google Scholar 

  16. Adsay NV, Fukushima N, Furukawa T, Hruban RH, Klimstra DS, Kloppel G, et al. Intraductal neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of thedigestive system. 4th ed. Lyons: IARC; 2010. p. 304–13.

    Google Scholar 

  17. Hruban RH, Adsay NV, Albores-Saavedra J, Compton C, Garrett ES, Goodman SN, et al. Pancreatic intraepithelial neoplasia: a new nomenclature and classification system for pancreatic duct lesions. Am J Surg Pathol. 2001;25:579–86.

    Article  CAS  PubMed  Google Scholar 

  18. Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977–87.

    Article  PubMed  Google Scholar 

  19. Furukawa T, Kloppel G, Volkan Adsay N, Albores-Saavedra J, Fukushima N, Horii A, et al. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch. 2005;447:794–9.

    Article  PubMed  Google Scholar 

  20. Treadwell TA, White RR 3rd. Primary tumors of the small bowel. Am J Surg. 1975;130:749–55.

    Article  CAS  PubMed  Google Scholar 

  21. Zollinger RM Jr. Primary neoplasms of the small intestine. Am J Surg. 1986;151:654–8.

    Article  PubMed  Google Scholar 

  22. Neugut AI, Jacobson JS, Suh S, Mukherjee R, Arber N. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev. 1998;7:243–51.

    CAS  PubMed  Google Scholar 

  23. Naef M, Buhlmann M, Baer HU. Small bowel tumors: diagnosis, therapy and prognostic factors. Langenbecks Arch Surg. 1999;384:176–80.

    Article  CAS  PubMed  Google Scholar 

  24. Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol. 2001;33:267–82.

    Article  CAS  PubMed  Google Scholar 

  25. Abu-Hamda EM, Hattab EM, Lynch PM. Small bowel tumors. Curr Gastroenterol Rep. 2003;5:386–93.

    Article  PubMed  Google Scholar 

  26. Hatzaras I, Palesty JA, Abir F, Sullivan P, Kozol RA, Dudrick SJ, et al. Small-bowel tumors: epidemiologic and clinical characteristics of 1260 cases from the connecticut tumor registry. Arch Surg. 2007;142:229–35.

    Article  PubMed  Google Scholar 

  27. Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. J Am Coll Surg. 1998;186:664–8.

    Article  PubMed  Google Scholar 

  28. Georgopoulos S, Pikoulis E, Bacoyiannis C, Tsigris C, Felekouras E, Leppaniemi A, et al. Combined abdominal aortic aneurysmectomy and other abdominal operations. Scand J Surg. 2004;93:61–3.

    CAS  PubMed  Google Scholar 

  29. Kurata S, Nawata K, Nawata S, Hongo H, Suto R, Nagashima H, et al. Surgery for abdominal aortic aneurysms associated with malignancy. Surg Today. 1998;28:895–9.

    Article  CAS  PubMed  Google Scholar 

  30. Matsumoto K, Murayama T, Nagasaki K, Osumi K, Tanaka K, Nakamaru M, et al. One-stage surgical management of concomitant abdominal aortic aneurysm and gastric or colorectal cancer. World J Surg. 2002;26:434–7.

    Article  PubMed  Google Scholar 

  31. Shimada Y, Sogawa M, Okada A, Namura O, Hayashi J, Iiai T, et al. A single-stage operation for abdominal aortic aneurysm with concomitant colorectal carcinoma. Ann Thorac Cardiovasc Surg. 2005;11:339–42.

    PubMed  Google Scholar 

  32. Tompkins WC Jr, Chavez CM, Conn JH, Hardy JD. Combining intra-abdominal arterial grafting with gastrointestinal or biliary tract procedures. Am J Surg. 1973;126:598–600.

    Article  PubMed  Google Scholar 

  33. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.

    Article  PubMed  Google Scholar 

  34. Takaori K, Kobashi Y, Matsusue S, Matsui K, Yamamoto T. Clinicopathological features of pancreatic intraepithelial neoplasias and their relationship to intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg. 2003;10:125–36.

    Article  PubMed  Google Scholar 

  35. Biankin AV, Kench JG, Biankin SA, Lee CS, Morey AL, Dijkman FP, et al. Pancreatic intraepithelial neoplasia in association with intraductal papillary mucinous neoplasms of the pancreas: implications for disease progression and recurrence. Am J Surg Pathol. 2004;28:1184–92.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the staff of the Department of Pathology, Tohoku University Hospital for their assistance and Enago (http://www.enago.jp) for the English language review.

Conflict of interest

We have no conflict of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroshi Okamoto.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Okamoto, H., Fujishima, F., Ishida, K. et al. Intraductal papillary mucinous neoplasm originating from a jejunal heterotopic pancreas: report of a case. Surg Today 44, 349–353 (2014). https://doi.org/10.1007/s00595-012-0486-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0486-0

Keywords

Navigation