A Case of Double Cancer of Ectopic Pancreatic Cancer and Primary Ovarain Cancer Presented with Intestinal Obstruction

Abstract

A 73-year-old woman presented to the emergency department in our hospital with vomiting and abdominal pain. Abdominal contrast-enhanced CT scan showed a dilated small intestine, an enlarged left ovary, and multiple nodules in the greater omentum peritoneum and mesentery. PET/CT scan showed abnormally high accumulation of FDG in the nodules of the left ovary, peritoneum, and mesentery, but not in the pancreas. Abdominal hysterectomy, adnexectomy, and small bowel resection were performed with the diagnosis of intestinal obstruction due to peritoneal metastasis of left ovarian cancer. Intraoperative findings showed a swollen left ovary and multiple nodules in the omentum, peritoneum, and mesentery. In addition, a 4-cm nodule was found in the mesentery of the jejunum about 1 cm from the ligament of Treitz, and another nodule was found in the serosa of the ileum 20 cm from the ileocecal region. The uterus and bilateral appendages were resected, and the omentum was removed as much as possible. About 10 cm and about 5 cm of the jejunum with a nodule in the mesentery and the ileum with a nodule in the serosa were excised and anastomosed.

The postoperative course was uneventful and she was discharged on the 12th postoperative day.

Histopathology revealed pancreatic tissue-derived adenocarcinoma in all ileum, jejunum, and omentum nodules. In addition, we observed the collision between the dissemination of primary ovarian cancer (mucinous adenocarcinoma) and pancreatic tissue-derived adenocarcinoma in both ovaries. The final diagnosis was double cancer of ectopic pancreatic cancer with peritoneal dissemination and metastasis and primary ovarian cancer. When we searched for the keywords “ectopic pancreatic cancer” and “double cancer” in the central journal of medicine (Ichu-Shi Web), there was only one case of duplication with gastric cancer. We report this case because of its rarity.