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Kawaguchi S, Murakami A, Nishida M. Duodenal Heterotopic Pancreas with a Large Retention Cyst: A Case Report and Literature Review. Intern Med 2023; 62:723-727. [PMID: 35871586 PMCID: PMC10037013 DOI: 10.2169/internalmedicine.0227-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 75-year-old man was referred to our hospital with a suspected pancreatic cyst. Imaging tests revealed a 3-cm cystic lesion located ventrally in the duodenal bulbus, which was suspected to be a duplication cyst with its muscularis propria contiguous to that of the duodenum. One year later, the cyst grew to 6 cm due to intracystic hemorrhaging; therefore, surgery was performed. Histopathology revealed a heterotopic pancreas (HP) in the duodenal wall. The diagnosis was a large, non-malignant retention cyst. Inflammation due to impaired outflow of pancreatic juice from the HP was identified as the cause of cyst enlargement.
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Affiliation(s)
- Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Japan
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2
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Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management. JOURNAL OF ONCOLOGY 2022; 2022:6983460. [PMID: 35586207 PMCID: PMC9110201 DOI: 10.1155/2022/6983460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022]
Abstract
Purpose To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal. Design From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists. Results The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known. Conclusion Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.
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Johnson TA, Vinayak A, Heo JY, Green TA. Gastrointestinal Intramural Pancreatic Pseudocysts in a Dog: A Case Report and Human Literature Review. J Am Anim Hosp Assoc 2021; 58:96-104. [PMID: 34606594 DOI: 10.5326/jaaha-ms-6992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/11/2022]
Abstract
A 9.5 yr old Yorkshire terrier presented with chronic intermittent vomiting and lethargy of 1.5 yr duration that progressed to generalized weakness. Insulin:glucose ratio was consistent with an insulinoma. Triple-phase computed tomography revealed a mid-body pancreatic nodule. The mid-body pancreatic nodule was enucleated; histopathology was consistent with an insulinoma. Two weeks after the operation, the dog presented for anorexia and diarrhea. Abdominal ultrasound revealed a thick-walled cystic lesion along the dorsal stomach wall. An intramural gastric pseudocyst was diagnosed via exploratory laparotomy and intraoperative gastroscopy. Comparison of amylase and lipase levels of the cystic fluid with that of concurrent blood serum samples confirmed the lesion was of pancreatic pseudocyst origin. The gastric pseudocyst was omentalized. Two weeks after the operation, the dog re-presented for anorexia, regurgitation, and diarrhea. An intramural duodenal pseudocyst was identified and treated with a duodenal resection and anastomosis. The dog has remained asymptomatic and recurrence free based on serial abdominal ultrasounds 22 mo following insulinoma removal. To our knowledge, this phenomenon of pancreatic pseudocysts forming in organs other than the pancreas has not been reported in dogs. This case report and comprehensive human literature review purpose is to raise awareness of this disease process in dogs.
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Li K, Xu Y, Liu NB, Shi BM. Asymptomatic gastric adenomyoma and heterotopic pancreas in a patient with pancreatic cancer: A case report and review of the literature. World J Clin Cases 2021; 9:8147-8156. [PMID: 34621874 PMCID: PMC8462214 DOI: 10.12998/wjcc.v9.i27.8147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastric adenomyoma (GA) is a rare submucosal benign neoplasm that occurs mostly in the gastric antrum and is often misdiagnosed. No standard treatment has been established for this disease in cases of malignancy.
CASE SUMMARY A 75-year-old woman with a 10-year history of hypertension was admitted to the Emergency Department of our hospital complaining of paroxysmal exacerbation of acute abdominal pain for 1 d with no apparent cause. Enhanced computed tomography and magnetic resonance imaging indicated a mass in the caudal pancreas, cholecystitis, and cholecystic polypus. Gastrointestinal endoscopy showed a mass arising from the gastric antrum. Due to the imaging findings, pancreatic cancer (PC), gastric lesion, cholecystitis, and cholecystic polypus were our primary consideration. Radical pancreatectomy, splenectomy, and cholecystectomy were performed successfully, and the gastric tumor was locally resected. Postoperative paraffin specimens confirmed the diagnosis of caudal PC, GA, and heterotopic pancreas (HP). Unfortunately, the patient died 13 mo later due to PC metastases to the liver, lung, and adrenal glands.
CONCLUSION GA is a rare benign disease, especially when occurring with HP. It may stem from the same origin as HP. This is the first case report to date of a patient suffering from the simultaneous occurrence of GA, HP, and PC. GA is a lesion that can mimic other benign or malignant gastrointestinal diseases; thus, a definitive diagnosis depends on postoperative pathological biopsy. Although GA and HP are both benign lesions, they should be resected because there is a chance of malignancy. Additional research should be conducted to better understand these submucosal lesions.
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Affiliation(s)
- Kun Li
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
| | - Yan Xu
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
| | - Nan-Bin Liu
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
| | - Bao-Min Shi
- Department of General Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China
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Ectopic pancreatitis in the antral stomach causing gastric outlet obstruction: a case of successful resection. Clin J Gastroenterol 2019; 13:465-471. [PMID: 31758484 DOI: 10.1007/s12328-019-01073-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
Ectopic pancreas is a congenital developmental anomaly that may be caused by embryologic errors. The pathogenetic details of ectopic pancreas remain unclear, but it has gradually been determined to originate at the gene level. DNA errors during embryological development cause ectopic pancreas. Ectopic pancreas is generally asymptomatic and harmless throughout the patient's entire life; in very rare cases, however, it can be symptomatic and harmful, causing pain, fever, bleeding, and other adverse effects. We herein report an unusual case involving a 52-year-old Japanese woman who presented with nausea and vomiting due to inflammation of an ectopic pancreas in the gastric antrum. Ectopic pancreatitis caused severe pyloric stenosis, and she was unable to ingest food or water even after admission to the internal medicine ward. Ectopic pancreatitis is a very rare clinical condition, but clinicians should be cautious of this uncommon disease in patients who develop gastric outlet obstruction without cancer or ulcers. The present case report is clinically significant because surgical treatment (distal partial gastrectomy) relieved the patient's serious distress rapidly and successfully after unsuccessful conservative treatments for acute ectopic pancreatitis. Antrectomy (distal partial gastrectomy) might be useful for ectopic pancreas, especially in case of gastric outlet obstruction due to the ectopic pancreatitis.
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Iwahashi S, Nishi M, Yoshimoto T, Kashihara H, Takasu C, Tokunaga T, Miyatani T, Higashijima J, Yoshikawa K, Wada Y, Bando Y, Shimada M. A case of gastric heterotopic pancreas with gastroduodenal invagination. Surg Case Rep 2019; 5:110. [PMID: 31292813 PMCID: PMC6620227 DOI: 10.1186/s40792-019-0669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is a rare disease commonly found incidentally on imaging studies, at endoscopy or at autopsy and can be associated with abdominal pain, vomiting, heart burn, gastric outlet obstruction, and even dysphagia in very rare cases. Heinrich's classified HP into three groups, types1-3, with Heinrich's type 3 HP the rarest and difficult to diagnose properly because it has only pancreatic ducts but has no islet and acini. The aim of this study is to report a case of gastric outlet obstruction caused by type 3 HP with gastroduodenal invagination with reference to the literature and diagnosed finally by immuno-histochemical analysis. CASE PRESENTATION The case presented is a 40-year-old male presenting with vomiting and abdominal pain. Computed tomography (CT) revealed a cystic mass in the upper abdomen and he was referred to the Tokushima University. Gastric fiber showed that the pedunculated mass originated from the stomach. An open distal gastrectomy was performed. Pathologically, there was small glands proliferation in the sub-mucosal (SM) layer which was membrane and cytoplasm (MUC)1 positive and muscle proliferation. RESULTS This finding revealed the tumor as HP. Postoperative course was uneventful and the patient was discharged 12 days after surgery. The patient has remained well 12 months after surgery. CONCLUSIONS HP should be considered in the differential diagnosis of SM tumors with gastroduodenal invagination even if this is a rare symptom.
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Affiliation(s)
- Shoko Iwahashi
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan.
| | | | - Hideya Kashihara
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Chie Takasu
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Tomohiko Miyatani
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Jun Higashijima
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Kozo Yoshikawa
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Yuma Wada
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Department of Division of Pathology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, Tokushima, 770-8503, Japan
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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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Ryu KH, Kim YS, Choi YW. [Pancreatitis with Pseudocyst Arising from Ectopic Pancreas in a Chronic Alcoholism]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 66:297-9. [PMID: 26913298 DOI: 10.4166/kjg.2015.66.5.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Affiliation(s)
- George A Holman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of New Mexico, MSC10-5550, Albuquerque, NM, 87131, USA,
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Rana SS, Bhasin DK, Rao C, Gupta R. Intramural pseudocysts of the upper gastrointestinal tract. Endosc Ultrasound 2014; 2:194-8. [PMID: 24949395 PMCID: PMC4062274 DOI: 10.4103/2303-9027.121240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/04/2013] [Indexed: 12/30/2022] Open
Abstract
Background: Intramural pseudocysts or pseudocysts occurring in the gastrointestinal tract (GIT) wall are rare and there is a paucity of data on their clinical features and management. Patients and Methods: We retrospectively evaluated patients with intramural pseudocysts seen at our institution over the past 6 years. Intramural location was confirmed either on surgery or endoscopic ultrasound (EUS). Depending upon the symptoms, their control with the conservative medical therapy and procedural consent, the patients underwent EUS guided single time aspiration of the pseudocyst or transmural drainage or transpapillary drainage or surgery. Results: A total of 9 patients with intra mural pseudocysts (male: n = 8; mean age ± SD: 39.3 ± 8.0 years; age range: 24-54 years; five patients having chronic and four patients having acute pancreatitis) were studied. The pseudocysts were located in the wall of the second part of the duodenum in five patients, in the gastric wall in three patients and in the lower esophageal wall in one patient. The size of the pseudocysts ranged from 8 mm to 8 cm and 3/9 (33%) patients had associated extra mural pancreatic pseudocysts. All patients had abdominal pain on presentation. Along with pain the patients with duodenal intramural pseduocysts also had symptoms suggestive of gastric outlet obstruction (3) or jaundice (1). The patient with esophageal intramural pseudocyst had dysphagia along with abdominal pain. Majority of these patients could be successfully treated endoscopically with no significant complications. Conclusions: Intramural pseudocysts of the upper GIT are very rare and EUS is a useful investigational modality for diagnosing and treating them.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chalapathi Rao
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Gupta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Rocha HLOG, Bueno FKDN, Faraco J, Assef MS, Araki OM, Nakao F, Rossini LGB. Heterotopic pancreas complicated by pseudocyst in the gastric wall diagnosed by endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound 2014; 2:159-61. [PMID: 24949386 PMCID: PMC4062256 DOI: 10.7178/eus.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 07/10/2013] [Indexed: 01/04/2023] Open
Abstract
Heterotopic pancreas is usually asymptomatic and does not change throughout the patient's life, but sometimes it can present symp-toms and complications, which are rarely discrete in the literature. We present here a case of heterotopic pancreas in the gastric wall complicated with pseudocyst, and suggest that heterotopic pancreatic pseudocyst should be included in the differential diagnosis of gastric wall cysts.
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Affiliation(s)
- Haroldo Luís Oliva Gomes Rocha
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
| | | | - Jarbas Faraco
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
| | - Maurício Saab Assef
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
| | - Osvaldo Massatoshi Araki
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
| | - Frank Nakao
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
| | - Lucio Giovanni Bapttista Rossini
- Department of Endoscopy, Faculdade de Ciências Médicas Santa Casa de São Paulo, Centro Franco-Brasileiro de Ecoendoscopia, São Paulo, SP, Brazil
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12
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Bryan DS, Waxman I, Matthews JB. Gastric obstruction due to intramural pseudocyst associated with heterotopic pancreas. J Gastrointest Surg 2014; 18:1225-6. [PMID: 24668368 DOI: 10.1007/s11605-014-2511-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/17/2014] [Indexed: 01/31/2023]
Abstract
An unusual case of gastric outlet obstruction caused by a gastric intramural pseudocyst associated with heterotopic pancreas is illustrated. Heterotopic pancreas is defined as the presence of aberrant pancreatic tissue that is anatomically and vascularly distinct from the pancreas itself (Liu et al. Am Surg. 78:E141-3, 2012). Heterotopic pancreatic tissue has been reported in many locations along the gastrointestinal tract, identified most commonly in the stomach where it is usually an asymptomatic anatomic curiosity than a source of clinical concern. We encountered an unusual instance in which heterotopic pancreas in the distal stomach was associated with heterotopic pancreatitis and intramural pseudocyst formation that led to gastric obstruction.
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Affiliation(s)
- Darren S Bryan
- Biological Sciences Division, Department of Surgery, University of Chicago, Chicago, IL, USA
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Abstract
Heterotopic pancreas is the presence of pancreatic tissue lying outside of its normal location and lacking anatomic or vascular connections with the pancreas. Heterotopic pancreas can undergo inflammatory changes similar to the normal pancreatic gland. We present 2 rare cases showing increased (18)F-FDG uptake in the heterotopic pancreatitis of the stomachs. To our knowledge, heterotopic pancreatitis with increased tracer accumulation on FDG PET/CT has not been reported before. Heterotopic pancreas should be included in the differential diagnosis of abnormal gastric FDG accumulation along with tumor and infectious processes.
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14
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Intramural pseudocyst of the duodenum caused by pancreatic head cancer: report of a case. Surg Today 2012; 42:805-7. [PMID: 22391978 DOI: 10.1007/s00595-012-0154-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 07/18/2011] [Indexed: 10/28/2022]
Abstract
An intramural pseudocyst in the alimentary tract develops as a rare complication of acute pancreatitis or trauma. A 60-year-old woman with pancreatic head cancer underwent preoperative radiological examinations, which revealed a 45-mm cystic mass around the second portion of the duodenum. Endoscopic ultrasonography confirmed a cystic lesion in the submucosal layer of the duodenum and fine needle aspiration cytology of the cystic contents suggested adenocarcinoma. The cystic fluid was amylase-rich, at 17040 U/l. We performed pancreaticoduodenectomy for the pancreatic head cancer. Pancreatography of the resected specimen showed a communication between the main pancreatic duct and the cystic lesion. The cut surface of the resected specimen revealed a cystic lesion, which surrounded the duodenum. Pathologically, the cystic lesion was diagnosed as a pseudocyst, located between the dissociated smooth muscle layers of the duodenum.
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Tsapralis D, Charalabopoulos A, Karamitopoulou E, Schizas D, Charalabopoulos K, Liakakos T, Macheras A. Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature. Diagn Pathol 2010; 5:4. [PMID: 20205774 PMCID: PMC2823681 DOI: 10.1186/1746-1596-5-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 01/14/2010] [Indexed: 12/26/2022] Open
Abstract
A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN) arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall.
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Affiliation(s)
- Dimitrios Tsapralis
- Department of Pathology, Athens University Medical School, Attikon University Hospital, Athens, Greece
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16
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Zarand A, Bajtai A, Baranyai Z, Dede K, Jakab F. Inflammation of ectopic pancreatic tissue in a Meckel's diverticulum causing acute abdominal symptoms: a case report and review of the literature. Int J Surg Pathol 2009; 19:359-63. [PMID: 19223375 DOI: 10.1177/1066896909331995] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An unusual case of acute abdomen was caused by the inflammation of ectopic pancreatic tissue in a Meckel's diverticulum. A 49-year-old man presented with acute abdominal pain, and the clinical diagnosis of acute appendicitis was established. During laparotomy, a normal appendix of unusual localization near the gallbladder and a Meckel's diverticulum with an inflamed tip were found. Histological examination showed acute inflammation of heterotopic pancreatic tissue along with normal ectopic gastric and duodenal mucosa within the wall of the diverticulum. Fat necrosis was also ascertained. The authors believe that this is the first report of acute inflammation of ectopic pancreatic tissue and the presence of normal ectopic gastric and duodenal tissue in the same Meckel's diverticulum.
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Affiliation(s)
- Attila Zarand
- Department of Surgery and Vascular Surgery, Uzsoki Hospital, Uzsoki Street 29, H-1145 Budapest, Hungary.
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Oh JY, Nam KJ, Choi JC, Cho JH, Yoon SK, Choi SS, Kwon HJ, Yoon JH, Kim SJ. Benign submucosal lesions of the stomach and duodenum: Imaging characteristics with endoscopic and pathologic correlation. Eur J Radiol 2008; 67:112-24. [PMID: 17720347 DOI: 10.1016/j.ejrad.2007.06.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2007] [Revised: 06/08/2007] [Accepted: 06/29/2007] [Indexed: 01/07/2023]
Abstract
Benign submucosal lesions of the stomach and duodenum are occasionally encountered during endoscopy. But endoscopy has its limitations in the diagnosis and differentiation of these lesions, because submucosal lesions are often difficult to visualize at endoscopy due to minimal change of the overlying mucosa. Furthermore, endoscopic biopsy may not always yield adequate tissue for diagnosis due to the submucosal location of the lesions. For this reason, the role of radiologic imaging is important in the diagnosis of submucosal lesions of the stomach and duodenum. Recent advances in computed tomography (CT) and sonographic technology are helpful in narrowing the differential diagnosis of gastroduodenal submucosal lesions. In contrast to endoscopy and barium studies, CT or ultrasonography (US) provides information about both the gastric wall and the extragastric extent of the disease. Arterial phase contrast enhanced CT enables us to discriminate a mass of submucosal from that of a mucosal origin in the differential diagnosis of gastric or duodenal lesions. Although endoscopic sonography has been considered the better modality in the diagnosis of gastroduodenal submucosal lesions, transabdominal sonography can still be an alternative method to endoscopic sonography in assessing of the origin and character of the submucosal lesions. Some gastroduodenal submucosal lesions have similar radiologic findings that make differentiation difficult. But despite overlaps in radiologic findings, some lesions have characteristic radiologic features that may suggest a specific diagnosis. Knowledge of the differential diagnosis of benign submucosal lesions in the stomach and duodenum may promote correct diagnosis and appropriate treatment.
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Affiliation(s)
- Jong Young Oh
- Department of Diagnostic Radiology, Dong-A University College of Medicine, Busan, Republic of Korea.
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Lindtner RA, Schreiber F, Langner C. Cytokeratin 7 immunostaining facilitates recognition of pancreatic heterotopia in gastric biopsies. Pathol Int 2007; 57:548-50. [PMID: 17610481 DOI: 10.1111/j.1440-1827.2007.02138.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Chiu HH, Liu YW, Li JH. Gastric intramural pseudocyst presenting as a gastric submucosal lesion. Clin Gastroenterol Hepatol 2007; 5:e20-1. [PMID: 17544987 DOI: 10.1016/j.cgh.2007.03.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Hsin-Hui Chiu
- Division of Gastroenterology, Department of Medicine, Kuo General Hospital, Tainan, Taiwan
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Kobayashi S, Okayama Y, Hayashi K, Sano H, Shiraki S, Goto K, Ohara H, Joh T. Heterotopic pancreas in the stomach which caused obstructive stenosis in the duodenum. Intern Med 2006; 45:1137-41. [PMID: 17106157 DOI: 10.2169/internalmedicine.45.1814] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The patient, a 43-year-old Japanese man suffering from duodenal ulcer and reflux esophagitis, was admitted to our hospital because of submucosal tumor in the antrum and obstructive stenosis of duodenum. Several imaging tests could not rule out the possibility of malignant disease. Therefore, the patient was surgically treated. Pathohistological examination of resected tissue demonstrated Heinrich type I heterotopic pancreas in the gastric lesion and submucosal abscess in the duodenal lesion with stenosis. In this case, it was considered that the heterotopic pancreas caused chronic inflammation to form the gastric tumor, and submucosal abscess leading to the severe duodenal stenosis.
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Affiliation(s)
- Shinya Kobayashi
- Department of Internal Medicine and Bioregulation, Nagoya City University Graduate School of Medical Sciences, Nagoya
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Affiliation(s)
- Daphne P Ly
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA
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Obermaier R, Walch A, Kurtz C, von Dobschuetz E, Adam U, Neeff H, Benz S, Hopt UT. Heterotopic pancreatitis with obstruction of the major duodenal papill--a rare trigger of obstructive orthotopic pancreatitis. Pancreatology 2004; 4:244-8. [PMID: 15148443 DOI: 10.1159/000078435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Heterotopic pancreas appears in 0.5 to 13% of autopsies. The most frequent locations are stomach, duodenum or upper jejunum. Pancreatitis in heterotopic pancreas is rarely described, and clinical symptoms caused by this heterotopic inflammation are uncommon. METHOD We report a case of heterotopic pancreatitis localized in the major duodenal papilla causing biliary obstruction and mimicking a pancreatic head tumor. Clinically and radiologically, malignancy was suspected. Preoperative biopsies showed only fibrosis. A pylorus preserving resection of the pancreatic head was performed followed by an uneventful postoperative course. RESULT Macroscopically, in the periampullary region on the pancreatic side a thickened duodenal wall with multiple lobules and cysts was found, compressing the common bile duct. Microscopic examination showed heterotopic pancreas with inflammatory lesions surrounding the ampulla. In the orthotopic pancreas a diffuse chronic pancreatitis with marked inflammation, fibrosis and atrophy of exocrine tissue was found. CONCLUSION In our case it was impossible to differentiate between chronic pancreatitis and pancreas carcinoma preoperatively. Radiological findings and endoscopic biopsies were not sufficient to distinguish heterotopic pancreatitis from other tumors of the pancreatic head. Clear diagnosis could only be made by complete histological examinations after pancreatic head resection, being the treatment of choice for pancreatic head tumors of unclear dignity. The differential diagnosis of heterotopic pancreatitis as trigger of unclear enlargement of the pancreatic head is very seldom.
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Affiliation(s)
- R Obermaier
- Department of Surgery, University of Freiburg, Freiburg, Germany.
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Wagholikar GD, Ibrarullah M, Venkataramanapa M. Gastric intramural pseudocyst--a complication of percutaneous drainage of an acute pancreatic pseudocyst. Am J Gastroenterol 2003; 98:229-31. [PMID: 12526979 DOI: 10.1111/j.1572-0241.2003.07192.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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