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Pang Y, Liu Y, Liu Q, Hou G. Intraductal Papillary Mucinous Neoplasm Arising from Heterotopic Pancreas in Stomach: A Case Report and Review of Literature. Int J Surg Pathol 2022:10668969221117990. [PMID: 35946106 DOI: 10.1177/10668969221117990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heterotopic pancreas is generally an asymptomatic condition which is found incidentally at surgery, endoscopy, or autopsy. Intraductal papillary mucinous neoplasm (IPMN) arising from heterotopic pancreas is extremely rare. In this study, we report a patient with IPMN arising from heterotopic pancreas. A 28-year-old man presented to our department with epigastric pain for 20 days. Physical examination revealed no abnormal findings. Computed tomography (CT) revealed an intramural cystic-solid mass on the gastric wall. Endoscopic ultrasonography (EUS) revealed a hypoechoic, heterogeneous, and multilobulated lesion with septa. Cyst fluid analysis based on EUS guided fine needle aspiration (EUS-FNA) indicated that the concentration of carcinoembryonic antigen (CEA) was 492 ng/ml. The patient received Billroth I subtotal gastrectomy, and then a 4.6 cm mass from the lesser curvature of the stomach was removed. Finally, the patient was diagnosed as IPMN with low grade dysplasia in an ectopic pancreas based on histopathological analysis. This report described the clinical, radiologic, endoscopic and histologic features of IPMN arising from heterotopic pancreas in a 28-year-old man involving the stomach. All pathologists involved in the diagnosis and clinicians involved in the treatment should be aware of this kind of tumor pattern to improve the correct identification, diagnosis and management of patients.
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Affiliation(s)
- Yu Pang
- Department of Pathology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
| | - Yuyu Liu
- Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
| | - Qinqin Liu
- Department of Hematology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
| | - Gang Hou
- Department of Pathology, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
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2
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Abena Hidangmayum, Kishan Prasad H. L., Jayaprakash Shetty K., Shreesha Khandige. Asymptomatic pancreatic heterotopia in an incidental Meckel's diverticulum – A rare case report. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pancreatic heterotopia is a rare, unusual finding where pancreatic tissues are found out of the normal anatomical location. Various studies have documented an incidence of 0.5 to 13% in autopsy. The reports on pancreatic heterotopia presence is rare, with an incidence estimated to be around 0.2% of all upper gastrointestinal surgeries. The heterotopic pancreas occurs frequnetly in the stomach, duodenum and proximal jejunum. Remote cases of pancreatic heterotopia in Meckel's diverticulum is a rare finding. These heterotopias are often clinically silent and are an incidental findings upon pathological examination or autopsy.
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3
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Kimura J, Okabayashi T, Sui K, Murokawa T, Tabuchi M, Aida M, Iwata J, Hata Y. Clinicopathological features of intraductal papillary mucinous neoplasm derived from ectopic pancreas: A systematic review. Surg Open Sci 2022; 8:62-68. [PMID: 35392578 PMCID: PMC8980485 DOI: 10.1016/j.sopen.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023] Open
Abstract
Background Methods Results Conclusion The ectopic pancreas can be complicated with pancreatitis, pseudocyst formation, cyst formation, insulinoma, adenoma, and malignant transformation. Intraductal papillary mucinous neoplasm (IPMN) derived from the ectopic pancreas is rare and can undergo malignant transformation. It is challenging to diagnose IPMN derived from ectopic pancreas preoperatively using the existing imaging modalities. Moreover, the clinicopathological characteristics of these tumors have not been elucidated. We performed a review of case reports on IPMNs derived from the ectopic pancreas, including intraductal papillary mucinous carcinoma (IPMC) that was treated in our hospital, to determine the clinicopathological features of the tumors. This is the first systematic review of the literature on IPMN derived from the ectopic pancreas. The review revealed that IPMN derived from the ectopic pancreas was diagnosed incidentally in most patients, and some patients were asymptomatic. The existing imaging modalities may not accurately diagnose the condition preoperatively and differentiate between IPMN and IPMC. Risk factors for malignant transformation should be clarified through further research.
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4
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Nambu N, Yamasaki T, Nakagomi N, Kumamoto T, Nakamura T, Tamura A, Tomita T, Miwa H, Shinohara H, Hirota S. A case of ectopic pancreas of the stomach accompanied by intraductal papillary mucinous neoplasm with GNAS mutation. World J Surg Oncol 2021; 19:309. [PMID: 34674710 PMCID: PMC8529847 DOI: 10.1186/s12957-021-02424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ectopic pancreas is basically a benign disease and is not always necessary to be removed. However, all types of neoplasms occurring in the normal pancreas such as ductal adenocarcinomas and intraductal papillary mucinous neoplasms (IPMNs) may develop even within ectopic pancreas. We recently encountered an extremely rare case of ectopic pancreas in the gastric antrum associated with IPMN possessing a GNAS mutation. CASE PRESENTATION A 71-year-old Japanese woman complained of epigastric pain. Computed tomography and upper gastrointestinal endoscopy showed an intramural cystic mass in the antrum of the stomach. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy did not give a definitive diagnosis, and the patient underwent resection of the lesion. Histology of the resected specimen showed that the gastric intramural lesion was ectopic pancreas. Moreover, the lesion contained dilated duct components with tubulo-villous epithelial proliferation consistent with pancreatic IPMN. Since the covering epithelial cells had highly atypical nuclei, the lesion was diagnosed as IPMN with high grade dysplasia. Immunohistochemistry showed that the IPMN component showed to be MUC2-, MUC5AC-, and CDX2-positive but MUC1- and MUC6-negative. Mutational analyses using genomic DNA revealed that the IPMN component had a mutation of GNAS at exon 8 (Arg201Cys). CONCLUSION We finally diagnosed this case as gastric ectopic pancreas accompanied by intestinal type IPMN with high grade dysplasia possessing GNAS mutation. Although there were 17 cases of ectopic pancreas with IPMN including 6 cases of gastric ones reported in the English literature, this is the first case of ectopic pancreas with IPMN which was proved to have GNAS mutation. Intimate preoperative examinations including imaging analyses and EUS-FNA biopsy/cytology are recommended to decide whether the lesion has to be resected or not even if they are not effective for getting the right diagnosis.
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Affiliation(s)
- Naoko Nambu
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takashi Yamasaki
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Nami Nakagomi
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tsutomu Kumamoto
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuro Nakamura
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akio Tamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
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5
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Hisanaga E, Sano T, Kubo N, Ishii N, Shirabe K, Takagi H, Hirato J, Ikota H. Adenocarcinoma with intraductal papillary mucinous neoplasm arising in a duodenal heterotopic pancreas: a case report. Clin J Gastroenterol 2020; 13:1373-1382. [PMID: 32909157 DOI: 10.1007/s12328-020-01224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023]
Abstract
A woman in her 70 s was diagnosed with a tumor in her duodenal wall during a routine visit for diabetes. She subsequently underwent subtotal stomach-preserving pancreatoduodenectomy. Histologically, the tumor was present mainly in the duodenal wall, and atypical cystic ducts were seen in the muscularis propria and subserosa. Invasive well-differentiated adenocarcinoma was seen in the duodenal submucosal and mucosal layers. Heterotopic pancreatic tissue was seen within the tumor, and atypical epithelium had proliferated and replaced the cystic ductal epithelium of the heterotopic pancreas. Therefore, adenocarcinoma with intraductal papillary mucinous neoplasm arising in duodenal heterotopic pancreas was the final histopathological diagnosis, which is considered rare.
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Affiliation(s)
- Etsuko Hisanaga
- Clinical Department of Pathology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Department of Internal Medicine, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan.
| | - Takaaki Sano
- Department of Diagnostic Pathology, Graduate School of Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hitoshi Takagi
- Department of Internal Medicine, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Junko Hirato
- Department of Pathology, Public Tomioka General Hospital, 2073-1 Tomioka, Tomioka, Gunma, 370-2393, Japan
| | - Hayato Ikota
- Clinical Department of Pathology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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6
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Saeed MF, Verhagen KR, Albinali S, Juma IM. A case report and literature review: incidental jejunal ectopic pancreatic tissue in an emergency bowel exploration for suspected intussusception. AME Case Rep 2019; 3:24. [PMID: 31463429 DOI: 10.21037/acr.2019.07.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/27/2019] [Indexed: 11/06/2022]
Abstract
Heterotopic pancreas (HP) is defined as pancreatic tissue which is an anatomically separate entity from the main pancreas and free from the organ's vascular or ductal continuity. Most cases of HP are asymptomatic and are diagnosed incidentally upon laparotomy or on autopsy. The diagnosis of HP can be extremely difficult. A few imaging modalities which include Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) may show characteristic features of HP. However, definitive diagnosis is made by histopathology. Conversely, these modalities may not differentiate a malignant neoplasm from a benign mass. Surgical excision is thought to be curative for HP. In this case report, we present a 62-year-old female with acute myelocytic leukemia on induction chemotherapy who developed abdominal pain during her hospital admission and was referred to the general surgery department. Abdominal computed tomography (CT) was done and showed signs of small bowel obstruction, perforation, and overlapping jejunoileal segments suggestive of intussusception. Upon surgical exploration two small bowel perforations were repaired, one iatrogenic and one pathological. On bowel run a jejunal mass was found, excised, and upon histopathology confirmed to be a mixed endocrine and exocrine heterotopic pancreatic choristoma. Definitive diagnosis of heterotopic pancreatic tissue is made by histopathology, and surgical excision is potentially curative. In conclusion, we recommend excising HP if found incidentally upon surgery as the diagnosis of HP and exclusion of neoplasm may not be possible without a histological specimen.
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Affiliation(s)
- Mirza Faraz Saeed
- Department of General Surgery, King Hamad University Hospital, Busaiteen, Bahrain
| | - Kiara Rebekka Verhagen
- Department of Obstetrics and Gynaecology, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sultan Albinali
- Department of Internal Medicine, King Hamad University Hospital, Busaiteen, Bahrain
| | - Isam Mazin Juma
- Department of Surgery, King Hamad University Hospital, Busaiteen, Bahrain
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7
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Pendharkar D, Khetrapal S, Jairajpuri ZS, Rana S, Jetley S. Pancreatic and Gastric Heterotopia in the Gallbladder: A Rare Incidental Finding. Int J Appl Basic Med Res 2019; 9:115-117. [PMID: 31041176 PMCID: PMC6477957 DOI: 10.4103/ijabmr.ijabmr_109_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heterotopic or ectopic tissue is a congenital anomaly, which is defined as the presence of the tissue outside its normal location, without neural, vascular, or anatomic connection with the main body of an organ in which it normally exists. This tissue is usually discovered incidentally and may be asymptomatic or may present with nonspecific gastrointestinal (GI) symptoms. Pancreatic and gastric heterotopia are the two predominantly occurring heterotopic tissues in the GI tract.[12] The prevalence of ectopic pancreatic tissue in the GI tract ranges from 0.6% to 13.7% of autopsy series and it can be present anywhere in the GI tract with the most common localizations being stomach (27.5%), duodenum (25.5%), colon (15.9%), esophagus, and Meckel's diverticulum.[345] It is a rare finding in the gallbladder and its prevalence has not been ascertained due to lack of large-scale studies and systematic review of literature. Similarly, heterotopic gastric tissue is common throughout the GI tract from the tongue to the rectum,[67] but it is extremely rare in the gallbladder with only around 34 cases reported in literature so far, while other cases of different types of heterotopic tissues in the gallbladder such as liver tissue and others such as adrenal and thyroid tissues have been described.[8] The most common presentation of ectopic tissue in the gallbladder is colicky pain in the epigastrium or right upper quadrant sometimes associated with nausea and vomiting. Here, we are presenting two incidentally detected cases, each of gastric and pancreatic heterotopias in the gallbladder.
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Affiliation(s)
- Devyani Pendharkar
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Shaan Khetrapal
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Zeeba Shamim Jairajpuri
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Safia Rana
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
| | - Sujata Jetley
- Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India
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8
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Noda E, Kuroda K, Sera T, Mori T, Kinoshita H, Hasegawa T, Teraoka H, Chikugo T. Intraductal papillary mucinous neoplasm originating from a heterotopic pancreas within the jejunum: a case report. J Surg Case Rep 2018; 2018:rjy181. [PMID: 30093986 PMCID: PMC6077795 DOI: 10.1093/jscr/rjy181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/14/2018] [Indexed: 11/17/2022] Open
Abstract
We report a case of intraductal papillary mucinous neoplasm arising within the heterotopic pancreatic tissue which was found incidentally in the jejunum during surgery for bowel obstruction. A 54-year-old female patient was admitted to our hospital due to sudden abdominal pain. In preoperative findings, we diagnosed bowel obstruction and performed surgery. Intra-operative findings showed adhesive intestinal obstruction, we performed synechiotomy for adhesion release. During surgery, when searching the small intestine, we coincidentally found a tumor in the jejunum and partial resected the jejunum. Pathological examination revealed a 1.2 cm × 1.0 cm × 1.0 cm white yellow nodule with cystic spaces. Histological examination demonstrated heterotopic pancreatic tissue consisting of well-formed lobules of pancreatic acini and cystically dilated ducts containing intraductal papillary neoplasm. Moreover, in immunohistochemical staining, MUC5AC was diffusely expressed, but not MUC1, MUC2 and MUC6.
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Affiliation(s)
- Eiji Noda
- Department of Surgery, Pegasus-Baba Memorial Hospital, Sakai-shi, Osaka, Japan
| | - Kenji Kuroda
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomohisa Sera
- Department of Surgical Oncology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuya Mori
- Department of Surgery, Pegasus-Baba Memorial Hospital, Sakai-shi, Osaka, Japan
| | - Haruhito Kinoshita
- Department of Surgery, Pegasus-Baba Memorial Hospital, Sakai-shi, Osaka, Japan
| | - Tsuyoshi Hasegawa
- Department of Surgery, Pegasus-Baba Memorial Hospital, Sakai-shi, Osaka, Japan
| | - Hitoshi Teraoka
- Department of Surgery, Pegasus-Baba Memorial Hospital, Sakai-shi, Osaka, Japan
| | - Takaaki Chikugo
- Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
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9
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Koukourakis IM, Perente Memet MS, Kouroupi M, Simopoulos K. Ectopic Pancreatic Tissue Adherent to the External Gallbladder Wall. Case Rep Gastroenterol 2018; 12:170-175. [PMID: 29805362 PMCID: PMC5968295 DOI: 10.1159/000488445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/14/2018] [Indexed: 12/16/2022] Open
Abstract
Heterotopic pancreatic tissue can be found in the gastrointestinal tract, with the stomach and small bowel being the most common sites of localization. The gallbladder is seldom affected. Here, we report 2 cases of ectopic pancreas within the fatty tissue adherent to the organ wall. Both cases concerned young women (31 and 36 years old) who were treated with a laparoscopic cholecystectomy due to persistent abdominal symptoms thought to be related to chronic cholecystitis. Pathological examination revealed the presence of ectopic pancreatic tissue type 1.
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Affiliation(s)
| | | | - Maria Kouroupi
- Department of Pathology, Democritus University of Thrace, Alexandroupolis, Greece
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10
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Gottschalk U, Dietrich CF, Jenssen C. Ectopic pancreas in the upper gastrointestinal tract: Is endosonographic diagnosis reliable? Data from the German Endoscopic Ultrasound Registry and review of the literature. Endosc Ultrasound 2018; 7:270-278. [PMID: 28836514 PMCID: PMC6106155 DOI: 10.4103/eus.eus_18_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Ectopic pancreas (EP) belongs to the most frequent subepithelial lesions (SELs) of the upper gastrointestinal (GI) tract. In the majority of cases, it is detected incidentally. Differential diagnosis from mesenchymal subepithelial tumors may be difficult. Methods: Among 24,308 endosonographic examinations and interventions, which were prospectively enrolled in the database of the German Endoscopic Ultrasound (EUS) Registry from January 2009 to August 2013, 575 were performed for suspected SELs of the upper GI tract. Sixty three cases of EP of the upper GI tract (stomach, n = 53; duodenum, n = 10; esophagus, n = 0) were extracted and retrospectively reviewed. Results: In 65.1% of cases, radial echoendoscopes or radial miniprobes were used for examination. Nearly 84% of EP was found in the stomach, 16% in the duodenum, none in the esophagus. In 88.9% of cases, the EUS examination discerned the layer of origin. In 59% of cases EP was described as a heterogeneous, in 28.6% as a homogeneous-hypoechoic and in 7.9% as a homogeneous-echogenic subepithelial mass lesion. Mean diameter was 13.0 mm × 8.1 mm, the mean ratio between long and short axis diameter was 1.75. EUS-guided fine needle aspiration (EUS-FNA) was used to accomplish cytological or histological diagnosis in only 6.3% of cases. Conclusions: EP accounts for 11% of all EUS examinations performed for subepithelial lesions of the upper GI tract and prospectively enrolled in the German EUS registry. Rather than being an eyecatcher, EP is a chameleon with numerous differential diagnoses. In selected cases, EUS-FNA may help clarifying the diagnosis.
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Affiliation(s)
- Uwe Gottschalk
- Medical Department, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany
| | - Christoph F Dietrich
- Medical Department, Caritas Krankenhaus, Uhlandstr 7, D-97980, Bad Mergentheim, Germany
| | - Christian Jenssen
- Medical Department, Krankenhaus Märkisch Oderland, Strausberg/Wriezen, Germany
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11
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Magenausgangsstenose bei unklarem Tumor der distalen Magenwand. Chirurg 2017; 88:1057-1058. [DOI: 10.1007/s00104-017-0464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Heterotopic Pancreas of the Gastrointestinal Tract and Associated Precursor and Cancerous Lesions: Systematic Pathologic Studies of 165 Cases. Am J Surg Pathol 2017; 41:833-848. [PMID: 28368927 DOI: 10.1097/pas.0000000000000850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heterotopic pancreas (HP) can be detected by accompanying symptoms or incidentally during gastrointestinal (GI) tract tumor resection. We compared clinicopathologic features among 165 resected HPs (57 gastric [35%], 56 duodenal [34%], 30 omental [18%], and 22 jejunal [13%]). Symptomatic HPs (79/135 GI tract wall HPs, 59%) were larger (P=0.05), more common in younger patients and in a gastric location (both P<0.001), and more frequently associated with lymphoid cuffs (P=0.03) than incidentally found HPs. Gastric/jejunal HPs were more frequently symptomatic (P<0.001), deeply located (P=0.03), and associated with lymphoid cuffs (P=0.008) and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; P=0.001) than duodenal HPs. HP was frequently associated with acinar-ductal metaplasias (117/135 GI tract wall HPs, 87%) and PanINs/IPMNs (68/135, 50%); those with PanINs/IPMNs were larger (P<0.001), more frequently located in stomach (P=0.001), had deeper wall involvement (P=0.03), and more often showed infiltrative growth (P<0.001) and lymphoid cuffs (P=0.02). Four HPs containing PanINs abutted adenocarcinomas, all expressing wild-type KRAS and intact SMAD4/DPC4 expression. Thus, symptomatic HP is associated with younger age, larger size, gastric location, and lymphoid cuffs. HPs containing PanINs/IPMNs (usually low grade) are larger and more common in stomach, have deeper wall location, and show infiltrative growth and lymphoid cuffs. Adenocarcinomas are rarely observed adjacent to HPs with PanINs/IPMNs. KRAS mutational and SMAD4/DPC4 immunohistochemical studies can discriminate between adenocarcinoma derived from HP and concurrent adenocarcinoma with HP.
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13
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The Role of Laparoscopy in the Management of a Diagnostic Dilemma: Jejunal Ectopic Pancreas Developing into Jejunojejunal Intussusception. Case Rep Surg 2017; 2017:8452947. [PMID: 28819577 PMCID: PMC5551536 DOI: 10.1155/2017/8452947] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/02/2017] [Indexed: 12/26/2022] Open
Abstract
Ectopic pancreas (EP) is a rare congenital anomaly defined as the presence of pancreatic tissue in topographic anomaly. It is usually silent but it may become clinically evident when complicated by acute conditions. The development of laparoscopic surgery has changed the way to manage such conditions, especially in the setting of emergency surgery, thanks to its diagnostic and therapeutic role with excellent results. We decided to perform an emergency diagnostic exploratory laparoscopy in a 29-year-old man with an acute abdomen and nonspecific radiological images for intestinal occlusion. A jejunojejunal intussusception was found, caused by a mass. We decided to carry out minilaparotomy to perform a resection of the affected jejunum. Histological examination confirmed the presence of a jejunal ectopic pancreas. Adult intussusception caused by EP represents 5% of all cases of intussusception. As CT scan, especially when performed in emergency setting for small bowel obstruction diagnosis, can usually demonstrate nondiagnostic findings suggestive of intussusception of unknown origin, laparoscopic exploration could help surgeons in order to perform a resolute diagnosis and treat the pathology.
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14
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Ruan M, Liu M, Cheng L, Xie W, Chen L. Increased 18F-FDG uptake of heterotopic pancreatitis in the small intestine: A CARE-compliant case report. Medicine (Baltimore) 2016; 95:e4465. [PMID: 27603341 PMCID: PMC5023863 DOI: 10.1097/md.0000000000004465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUD Heterotopic pancreas (HP), a relatively uncommon congenital anomaly, is rarely noted during F-FDG positron-emission tomography/computed tomography (PET/CT) scan. METHODS A 60-year-old woman was referred to our hospital due to a 10-day history of abdominal pain with elevated levels of serum amylase and lipase. Abdominal CT and ultrasound examinations were negative. In order to search for the cause, an F-FDG PET/CT whole body scan was suggested to an old woman revealing the presence of F-FDG accumulating nodule in small intestine. RESULTS Surgical findings and pathologic results confirmed the diagnosis of small intestinal heterotopic pancreas with active chronic inflammation. CONCLUSION This uncommon case underscores the necessity of considering heterotopic pancreatitis in small intestine with focal F-FDG uptake as a possible differential diagnosis in intestinal tumor and tuberculosis.
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Affiliation(s)
- Maomei Ruan
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Liu
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Lingxiao Cheng
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Libo Chen
- Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Correspondence: Libo Chen, Department of Nuclear Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (e-mail: ); Wenhui Xie, Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, P.R. China (e-mail: )
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15
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Ma C, Gocke CD, Hruban RH, Belchis DA. Mutational spectrum of intraepithelial neoplasia in pancreatic heterotopia. Hum Pathol 2015; 48:117-21. [PMID: 26626780 DOI: 10.1016/j.humpath.2015.09.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/05/2015] [Accepted: 09/18/2015] [Indexed: 12/30/2022]
Abstract
Heterotopic pancreatic parenchyma recapitulates the normal pancreas in extrapancreatic locations and, on rare occasions, can even give rise to pancreatic adenocarcinoma. The genetic signatures of pancreatic adenocarcinoma and its precursor lesions are well characterized. We explored the genetic alterations in precursor lesions (intraductal papillary mucinous neoplasms [IPMN], pancreatic intraepithelial neoplasia [PanIN]) in patients with pancreatic heterotopias but without concomitant pancreatic ductal adenocarcinomas. This allowed us to determine whether the stereotypical dysplasia--infiltrating carcinoma sequence also occurs in these extrapancreatic foci. Seven cases of heterotopic pancreas with ductal precursor lesions were identified. These included 2 IPMNs with focal high-grade dysplasia and 5 PanINs with low- to moderate-grade dysplasia (PanIN grades 1-2). Neoplastic epithelium was microdissected and genomic DNA was extracted. Sequencing of commonly mutated hotspots (KRAS, TP53, CDKN2A, SMAD4, BRAF, and GNAS) in pancreatic ductal adenocarcinoma and its precursor lesions was performed. Both IPMNs were found to have KRAS codon 12 mutations. The identification of KRAS mutations suggests a genetic pathway shared with IPMN of the pancreas. No mutations were identified in our heterotopic PanINs. One of the possible mechanisms for the development of dysplasia in these lesions is field effect. At the time of these resections, there was no clinical or pathologic evidence of a prior or concomitant pancreatic lesion. However, a clinically undetectable lesion is theoretically possible. Therefore, although a field effect cannot be excluded, there was no evidence for it in this study.
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Affiliation(s)
- Changqing Ma
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Ralph H Hruban
- The Sol Goldman Pancreatic Cancer Research Center, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21224
| | - Deborah A Belchis
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21224.
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16
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Lee SH, Kim WY, Hwang DY, Han HS. Intraductal papillary mucinous neoplasm of the ileal heterotopic pancreas in a patient with hereditary non-polyposis colorectal cancer: A case report. World J Gastroenterol 2015; 21:7916-7920. [PMID: 26167093 PMCID: PMC4491980 DOI: 10.3748/wjg.v21.i25.7916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/20/2015] [Accepted: 04/17/2015] [Indexed: 02/06/2023] Open
Abstract
We report a case of intraductal papillary mucinous neoplasm (IPMN) originating from the ileal heterotopic pancreas in a patient with hereditary non-polyposis colorectal cancer (HNPCC). A 49-year-old woman had a past history of total colectomy and total hysterectomy with bilateral salpingo-oophorectomy due to colonic adenocarcinoma and endometrial adenocarcinoma 11 years ago. Her parents died from colonic adenocarcinoma and her sister died from colonic adenocarcinoma and endometrial adenocarcinoma. The clinician found an ileal mass with necrotic change and the mass increased in size from 1.7 cm to 2.2 cm during the past 2 years on computed tomography. It was surgically resected. Microscopically, the ileal mass showed heterotopic pancreas with IPMN high grade dysplasia. Immunohistochemical staining revealed positive reactivity for MLH1/PMS2 and negative reactivity for MSH2/MSH6. This is the first report of IPMN originating from the ileal heterotopic pancreas in a patient with HNPCC in the English literature.
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MESH Headings
- Adenocarcinoma/genetics
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Biomarkers, Tumor/analysis
- Biopsy
- Choristoma
- Colectomy
- Colorectal Neoplasms, Hereditary Nonpolyposis/genetics
- Colorectal Neoplasms, Hereditary Nonpolyposis/pathology
- Colorectal Neoplasms, Hereditary Nonpolyposis/surgery
- Female
- Genetic Predisposition to Disease
- Heredity
- Humans
- Ileal Neoplasms/chemistry
- Ileal Neoplasms/pathology
- Ileal Neoplasms/surgery
- Immunohistochemistry
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/chemistry
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreas
- Pancreatic Neoplasms
- Phenotype
- Tomography, X-Ray Computed
- Tumor Burden
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17
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Kilius A, Samalavicius NE, Danys D, Zaldokas G, Seinin D. Asymptomatic heterotopic pancreas in Meckel's diverticulum: a case report and review of the literature. J Med Case Rep 2015; 9:108. [PMID: 25956067 PMCID: PMC4460693 DOI: 10.1186/s13256-015-0576-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/19/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Heterotopic pancreas is defined as pancreatic tissue without a real anatomical or vascular connection to the pancreas. It can be found in the stomach, duodenum, jejunum, ileum, Meckel’s diverticulum, colon gall bladder, umbilicus, fallopian tube, mediastinum, spleen and liver. Complications of heterotopic pancreas are inflammation, bleeding, obstruction, malignant transformation, carcinoid syndrome, jejunojejunal intussusception and ileus, but it is usually asymptomatic and diagnosed only during examinations for other diseases. Case presentation An 81-year-old Lithuanian woman was diagnosed with caecal cancer and had undergone elective surgery. A right hemicolectomy was performed and a Meckel’s diverticulum was observed and excised. Histological results showed a poorly differentiated G3 adenocarcinoma of her large intestine and heterotopic pancreas tissue in the Meckel’s diverticulum and mesenteric adipose tissue. Conclusions Asymptomatic heterotopic pancreas is rarely diagnosed, and usually found incidentally during surgical or diagnostic interventions. Although it has no symptoms, heterotopic pancreas found during surgical procedures should be excised.
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Affiliation(s)
- Alfredas Kilius
- Center of Oncosurgery, National Cancer Institute, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Narimantas Evaldas Samalavicius
- Center of Oncosurgery, National Cancer Institute, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Donatas Danys
- Center of Oncosurgery, National Cancer Institute, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Gytis Zaldokas
- Vilnius University, Medical Faculty, Vilnius, Lithuania.
| | - Dmitrij Seinin
- National Center of Pathology, P. Baublio 5, Vilnius, LT-08406, Lithuania.
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18
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Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm. Case Rep Surg 2015; 2015:816960. [PMID: 25793138 PMCID: PMC4352448 DOI: 10.1155/2015/816960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/14/2015] [Accepted: 01/17/2015] [Indexed: 12/19/2022] Open
Abstract
We report a unique first case of benign heterotopic pancreas arising within the proximal hepatic bile duct, containing a focus of intraductal papillary mucinous neoplasm (IPMN). The condition was diagnosed on pathological explant after left hepatic lobectomy with total extrahepatic bile duct excision.
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