Abstract
A 66-year-old woman had visited a nearby clinic with frequent hiccupping one month earlier. Gastric distension was noted on abdominal X-ray, and she was referred to our hospital with suspected pyloric stenosis. No abnormal findings other than abdominal bloating were apparent. Upper gastrointestinal endoscopy showed severe stenosis in the pylorus and a submucosal tumor-like protrusion at the center of the posterior wall. Biopsy identified a Group 1 mass, but invasion into the duodenal bulb was suspected on abdominal ultrasonography. Submucosal tumor-like gastric cancer could not be ruled out, and she underwent surgery for the purposes of definitive diagnosis and treatment of the obstruction. After distal gastrectomy conforming to treatment for gastric cancer with accompanying duodenal invasion, lymph nodes D2+No.12b/p, 13a, and 14v were dissected. Malignant transformation of an aberrant pancreas was diagnosed from histopathological examination. Lymph node metastasis was observed at No. 5, 6, 8a, and 13a.
General findings were pT3, pN2, sH0, sP0, pCY0, pM1, fStage IV. This case suggests that when gastric submucosal tumor is diagnosed, differential diagnosis should include primary adenocarcinoma of aberrant pancreas in the stomach, although this is rare, and a surgical procedure that takes lymph node metastasis into account should be considered.
