A Case of Heterotopic Pancreatic Cancer in the Jejunum

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A 78-year-old woman was admitted to our hospital because of abdominal pain, nausea, and vomiting. A plain abdominal X-ray showed both gas and a niveau in the small intestine. The symptoms and the niveau improved in response to conservative therapy, but the symptoms of intestinal obstruction recurred after she consumed a meal. Based on the symptoms and X-ray findings, the patient was diagnosed with intestinal obstruction of unknown etiology, and was operated. Intraoperatively, a tumor was palpated in the jejunum 50 cm distal to the ligament of Treitz. The tumor had invaded the entire thickness of the wall and was exposed beyond the serosa. The proximal bowel was extremely dilated, and partial jejunectomy was performed to relieve the obstruction. Gross examination of the specimen revealed a yellowish-brown protruding tumor, measuring 3×2 cm. The tumor was covered with intact mucosa and resembled a submucosal tumor. Histopathological examination showed that the tumor was developed from an aberrant pancreas composed of ducts, acini, and smooth muscle tissue. The tumor was located in the submucosa of the jejunum. The tumor consisted of moderately differentiated adenocarcinoma and was in contact with the aberrant pancreas. On the basis of these findings, the tumor was diagnosed as cancer of heterotopic pancreas in the jejunum.
It is extremely rare for aberrant pancreatic cancer to be located in the jejunum. Six cases of heterotopic pancreatic cancer in the jejumum have been reported in the literature, and our case appears to be the seventh.