Intraductal papillary mucinous neoplasm arising in a heterotopic pancreas treated by percutaneous endoscopic intragastric surgery

Abstract

We report a case of intraductal papillary mucinous neoplasm (IPMN) arising in the heterotopic pancreas of the stomach which was successfully removed by percutaneous endoscopic intragastric surgery (PEIGS). A 42-year-old man was given a diagnosis of gastric submucosal tumor (SMT) during a medical check-up. Abdominal CT scan and MRI imaging revealed a multicystic lesion in the tumor mass which was diagnosed as heterotopic pancreas with cystic component (IPMN or pseudocyst). The tumor was located in the antrum of the stomach and adjacent to the pyloric ring; therefore, we selected PEIGS as a surgical procedure to preserve gastric function for clinically benign tumor treatment. Pathological examination revealed multiple dilated pancreatic ducts with pyloric gland-like structures in the heterotopic pancreatic tissues. Based on pathological findings, the tumor was finally diagnosed as heterotopic pancreas with gastric type IPMN. We considered PEIGS as a suitable procedure for the intraluminal SMT adjacent to the pyloric ring for its functional preservation.