Heterotopic pancreatic tissue in a bronchogenic cyst-diagnosis and therapy

Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation

Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.

Ectopic pancreatic tissue in the stomach: Case report

Introduction: Ectopic pancreas is a rare developmental anomaly. It is a presence of pancreatic tissue without anatomic or vascular continuity with the normally developed pancreas. The most common heterotopic site is the stomach commonly involving antrum and prepyloric region on the greater curvature or posterior wall. Ectopic pancreas is diagnosed by endoscopic ultrasound, gastroscopy and biopsy, CT scan and MRI of the abdomen, a definitive diagnosis is verified by histopathological examination. Treatment is surgical. Case report: A 56-year-old woman presented with epigastric pain, nausea and fatigue. Esophagogastroduodenoscopy showed submucosal mass in the prepyloric region, biopsy was performed. Histopathological findings described normal gastric mucosa. Endoscopic ultrasonography and CT of the abdomen showed submucosal tumor, 18 mm in diameter, located in the prepyloric region. Surgical treatment was indicated. Gastrotomy with total extraction of tumor was performed. Histopathology findings showed ectopic pancreatic tissue in the submucosal and muscular layer of the stomach. Postoperatively patient fully recovered, and in the 2 year follow-up did not develop any symptoms related to gastrointestinal tract. Conclusion: Although presentation of ectopic pancreatic tissue in stomach is a very rare condition, it should be considered during gastroitestinal diagnostic in patients with nonspecific gastrointestinal symptomatology. In most of cases, for this patients, surgery is curative and definitive solution.

Gastric fundal heterotopic pancreas mimicking a gastrointestinal stromal tumour (GIST): a case report and a brief review

BACKGROUND

Heterotopic pancreas is a rare congenital condition characterised by pancreatic tissue lacking vascular or anatomic communication with the normal pancreas. Most cases of ectopic pancreas are asymptomatic. The preoperative diagnosis of this condition is difficult.

CASE PRESENTATION

A 50-year-old woman presented with dyspeptic symptoms of 4 years duration. Contrast enhanced CT (computed tomography) scan of abdomen suggested a gastrointestinal stromal tumour in the fundus of the stomach. The patient underwent laparoscopy assisted resection and subsequent histology revealed ectopic pancreatic tissue.

CONCLUSION

Although heterotopic pancreas is a rare lesion diagnosed on histology, it should be considered in the differential diagnosis of gastric mass lesions and in patients presenting with vague upper gastrointestinal symptoms.

Heterotopic pancreas in excluded stomach diagnosed after gastric bypass surgery

Background

Heterotopic pancreas is defined as finding of pancreatic tissue without anatomic and vascular continuity with the normal pancreas. Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management.

Case presentation

We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue. Before gastric bypass surgery, the presence of the pancreatic mass in the gastric wall was unnoticed in the imagiologic records.

Conclusion

This is the first reported case of pancreatic heterotopy diagnosed in the excluded stomach after gastric bypass. A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research.

[Bronchogenic cyst of the abdomen]

A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localisation within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95 x 75 x 70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.

Simultaneous acute inflammation in entopic and ectopic pancreas

The necropsy findings in an elderly woman, who had been treated with methyldopa and who had died during treatment for accidental hypothermia, showed acute periductal inflammation of obviously similar duration in an entopic pancreas in the wall of the jejunum and in the ectopic pancreas. This supports the hypothesis that attempted drug detoxification by pancreatic tissue can cause pancreatitis.

Bronchogenic cyst in the abdomen

A bronchogenic cyst was found in the abdomen, in the retroperitoneum adjacent to the superior pancreatic body. The cyst was unilocular and contained about 100 ml pale yellow mucinous fluid. Microscopic examination revealed a pseudostratified columnar ciliated or cuboidal epithelium, seromucous glands, smooth muscle and cartilage, the distinctive features of bronchogenic cysts. This aberrant location of the cyst is explicable if abnormal buds of the tracheobronchial tree are pinched off and migrate into the abdomen in an early embryonic stage before the canal linking the abdominal with the thoracic cavity is closed by fusion of the future components of the diaphragm.