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Published on: February 9, 2024
Pancreatic cancer mimicking ectopic pancreas origin: a rare case after neonatal pyloromyotomy
Yuta Hasegawa1, Takazumi Tsunenari1, Sho Ogata2
1Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, 359-8513, Saitama, Japan.
Insights
Neonatal pyloromyotomy for pyloric stenosis may lead to rare pancreatic cancer cases. This report details a 39-year-old woman with pancreatic cancer linked to abnormal pancreatic tissue embedding after surgery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Pediatric Surgery
Background:
- Infantile hypertrophic pyloric stenosis is commonly treated with pyloromyotomy.
- Long-term outcomes are generally safe, with few severe complications.
- Atypical presentations of gastrointestinal malignancies require careful surgical planning.
Purpose of the Study:
- To report the first known case of pancreatic cancer.
- To investigate the potential link between neonatal pyloromyotomy and pancreatic cancer.
- To highlight the importance of preoperative evaluation for anatomical alterations.
Main Methods:
- Case report of a 39-year-old woman with a history of neonatal pyloromyotomy.
- Diagnostic imaging to assess nausea, vomiting, and suspected cancer.
- Surgical exploration (laparotomy) and pancreaticoduodenectomy.
- Pathological examination of resected tissue.
Main Results:
- Pancreatic cancer confirmed, arising from ectopic pancreatic parenchyma within the pyloric ring.
- Patient underwent pancreaticoduodenectomy and adjuvant chemotherapy.
- Peritoneal dissemination occurred 23 months postoperatively.
- Abnormal pancreatic head embedding considered secondary to neonatal pyloromyotomy.
Conclusions:
- Neonatal pyloromyotomy may be associated with long-term anatomical alterations.
- These alterations could potentially predispose to pancreatic cancer.
- Further research is needed to establish a direct causal relationship.
- Careful preoperative assessment and surgical planning are crucial for managing such rare cases.
Abstract:
Pyloromyotomy is a technique for relieving infantile hypertrophic pyloric stenosis and is performed almost safely without severe complications during long-term outcomes. To the best of our knowledge, this is the first reported case of pancreatic cancer arising from the pancreatic parenchyma embedded within the pyloric ring after neonatal pyloromyotomy. A 39-year-old woman with a history of infantile hypertrophic pyloric stenosis underwent a pyloromyotomy during the neonatal period and presented with progressive nausea and vomiting. Imaging studies suggested the presence of ectopic pancreatic or gastric cancer invading the pancreas. After laparotomy, tumor invasion of the pancreatic head was identified; therefore, pancreaticoduodenectomy was performed. Pathological examination confirmed pancreatic cancer arising from the pancreatic parenchyma embedded within the duodenal and pyloric muscle layers. The patient completed 6 months of adjuvant chemotherapy with oral S-1. Peritoneal dissemination was observed 23 months postoperatively. Abnormal embedding of the pancreatic head in the walls of the duodenum and pyloric ring was considered to be related to neonatal pyloromyotomy. This alteration requires careful preoperative evaluation and flexible surgical planning to achieve curative resection of atypical presentations of gastrointestinal malignancies. The cancer in the present case may be associated with long-term anatomical alterations following neonatal pyloromyotomy, although a direct causal relationship cannot be established.
