Agenesis of the dorsal pancreas and its association with pancreatic tumors

Complete agenesis of dorsal pancreas: A rare cause of insulin-dependent diabetes mellitus

ABSTRACT

We report a 16-year-old boy who presented with abdominal pain and severe hyperglycemia. His random blood glucose on admission was above 300 mg/dL, without ketosis. Urine examination revealed mild ketonuria. Renal function tests were normal. Antibodies to glutamate acid decarboxylase (anti-GAD) and islet tyrosine phosphatase 2 (anti-IA2) were negative. Findings on enhanced abdominal computed tomography scan were compatible with complete dorsal pancreatic agenesis. The body and tail of the pancreas were not visualized. Additionally, ectopic and malrotated left kidney was detected. Magnetic resonance cholangiopancreatography confirmed the absence of the dorsal pancreatic duct. The patient was treated with multiple subcutaneous insulin injections and attained good glycemic control. He is currently doing well on follow-up. The present case is a rare combination of complete agenesis of the dorsal pancreas with an ectopic, malrotated kidney. Clinical awareness of this rare association will help improve patient management.

Agenesis of Dorsal Pancreas in a Young Adult: A Case Report

Dorsal agenesis of the pancreas is an exceedingly rare congenital anomaly where the dorsal part of the pancreas fails to develop properly during embryonic development. We report a case of partial agenesis of the dorsal pancreas in a 27-year-old female who presented with progressively worsening abdominal pain, nausea, vomiting, generalized weakness, easy fatigability, and dizziness. Physical examination revealed fair general condition with stable vital signs and normal abdominal and other system findings. Laboratory evaluations and abdominal computed tomography scan revealed an absence of the pancreatic body, tail, and duct of Santorini, confirming the diagnosis of partial agenesis of the dorsal pancreas. Only around 100 cases have been reported in the literature, making it a diagnostic challenge. Our case illustrates the rarity and challenges in diagnosing dorsal agenesis of the pancreas. Further research is needed to fully understand its causes and associations.

Keywords

agenesis; case reports; congenital; pancreas.

Agenesis of the Dorsal Pancreas: Case Report and Review of Age-Related Differences in Presentation

Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly that occurs when the body and tail of the pancreas fail to develop from the dorsal bud in utero. ADP may be discovered when evaluating conditions arising from the anomaly, such as diabetes mellitus, pancreatitis, and pancreatic insufficiency, but is more commonly found as an incidental finding. To date, fewer than 120 cases have been reported in the literature. We report a 6-year-old male who was found to have ADP on computed tomography during the investigation of abdominal pain and vomiting. We review the variable presentation, genetic mutations, and age-related differences between children and adults with this rare condition.

Pancreatic head sparing surgery for solid pseudopapillary tumor in patients with agenesis of the dorsal pancreas

BACKGROUND

This study aimed to clarify the feasibility and justification of pancreatic head sparing (PHS) enucleation for patients with agenesis of the dorsal pancreas (ADP) associated with a solid pseudopapillary tumor (SPT).

METHODS

Data of the SPT patients with and without ADP, including clinical presentations, surgical options, and surgical and survival outcomes, were recruited for comparison.

RESULTS

A total of 31 patients with SPTs were included, three of whom displayed ADP and underwent PHS enucleation. Surgical complications were comparable between the groups. Overall, the 5- and 10-year disease-free survival rates were 100% and 90%, respectively. The 20- and 25-year overall survival rates were 100% and 66.7%, respectively. Only one patient (3.2%) developed tumor recurrence 7.3 years after pancreatectomy for an SPT with lymph node involvement, and the patient survived 24.5 years after the initial operation. No tumor recurrence occurred in any patient with ADP after PHS enucleation.

CONCLUSION

PHS enucleation seems to be feasible and justifiable for SPT patients with ADP in terms of surgical and survival outcomes, and this approach could be recommended to avoid pancreatic insufficiency.

Laparoscopic total gastrectomy for concurrent gastric cancer and complete agenesis of the dorsal pancreas

We present an unusual case of laparoscopic total gastrectomy with lymph node dissection in a 56-year-old woman with gastric cancer and agenesis of the dorsal pancreas (ADP). Esophagogastroduodenoscopy revealed erosive lesions with thickened gastric folds; biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography showed a thickened wall of the gastric body; the distal pancreas was not visualized. Under the clinical diagnosis of gastric cancer with ADP, the patient underwent laparoscopic total gastrectomy with standard lymphadenectomy. The absence of a pancreatic neck, body, and tail was confirmed; lymph nodes along the splenic artery were dissected. Pathological analysis demonstrated a poorly differentiated adenocarcinoma invading the serosa, with five lymph node metastases. The postoperative course was unremarkable; postoperative adjuvant chemotherapy was performed using S-1 plus oxaliplatin. No symptom recurrence was observed at the 6-month follow-up. Laparoscopic surgery, with careful preoperative anatomic evaluation, can be considered for concurrent gastric cancer and ADP.

Complete agenesis of dorsal pancreas with pancreatic cyst: A case report

Agenesis of the dorsal pancreas (ADP) is extremely rare disease with no specific symptoms and there is no clear pathogenesis. Approximately half of the affected individuals develop diabetes resulting from reduced islet cell mass secondary to lack of endocrine structures. In this case, we aimed to present a 17-year-old female patient with ADP accompanied by a pancreatic cyst.

Partial agenesis of dorsal pancreas. Report of two cases

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Agenesis of the dorsal pancreas is a rare congenital anomaly.

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The possibility of finding this disorder is increasing with the use of advanced radiological techniques.

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Some patients experience no symptoms.

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Rarely, they may also develop pancreatic exocrine insufficiency or pancreatic adenocarcinoma.

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This diagnosis could be missed by US, due to difficulty on visualization of body and tail of pancreas.

Introduction

Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting in missing corpus and cauda of the pancreas. The possibility of finding this disorder is increasing with the use of advanced radiological techniques like CT scan or MRI.

Presentation of case

We reported 2 cases of a partial ADP as radiological finding: the first one was a 79-year-old asymptomatic patient who presented to perform a CT staging scan for bladder tumor, while the second case was a 73-year-old patient with obstructive jaundice and with suspected common bile duct calculi. In the second patient US, CT scan and MRI were performed, and after that also an ERCP was scheduled.

Discussion

The prevalence of agenesis of the dorsal pancreas is not exactly known; in the literature, only 50 cases have been reported. Its cause and pathogenesis are not fully understood. Some patients experience no symptoms, while others may develop hyperglycemia, diabetes mellitus, bile duct obstruction, abdominal pain, pancreatitis, or other conditions.

Conclusion

Considering that dorsal agenesis is sporadically found, often do not have related symptoms and it does not require a specific treatment, whether further examinations are needed to determine the type of agenesis remains questioned.

Agenesis of the dorsal pancreas: a very rare entity causing diabetes mellitus

Dorsal pancreatic agenesis is a very rare pancreatic developmental anomaly resulting in missing corpus and cauda of the pancreas. Due to improvements and more widespread use of advanced radiological techniques like CT or MRI, the possibility of finding this disorder is growing. Thus, this rare congenital condition, as well as a pancreas divisum and pseudo-agenesis secondary to chronic pancreatitis, must be considered in the differential diagnosis. Although most of the patients seem to be asymptomatic, abdominal pain and pancreatitis may develop. Moreover, this entity should be known by the treating physician, as these patients are at a high risk of developing diabetes mellitus during their lifetime. Herein, we present the case of a 65-year-old woman with complete agenesis of the dorsal pancreas. The patient was hospitalized due to weight loss, abdominal discomfort, and diabetes mellitus type 2.

Agenesis of dorsal pancreas associated with pancreatic neuroendocrine tumor: a case report and review of the literature

Background

Agenesis of the dorsal pancreas is very rare. Less than 70 cases have been reported to date. Some of these cases had an association with a tumor. The literature of agenesis of the dorsal pancreas and agenesis of the dorsal pancreas-associated pancreatic neoplasia is limited. Here we report the second case of a pancreatic neuroendocrine tumor in a setting of agenesis of the dorsal pancreas.

Case presentation

A 71-year-old man, originally from North Africa, with a history of insulin-dependent diabetes mellitus, presented with a 2-month history of nonspecific abdominal symptoms. Contrast-enhanced computed tomography demonstrated an almost 3 cm round, quite well-defined and homogeneous tumor formation in the area between the neck and absent body and tail of his pancreas. The mass was confirmed by endoscopic ultrasound. Our patient underwent computed tomography-guided biopsy of the mass which provided proof of a neuroendocrine tumor. He underwent pancreas resection because of the presence of a neuroendocrine tumor. Seven months later his glycated hemoglobin increased from 6.9 to 8.7%.

Conclusions

Diagnosis of agenesis of the dorsal pancreas is based on imaging techniques like computed tomography, magnetic resonance cholangiopancreatography, or endoscopic ultrasound. Endoscopic ultrasound-guided fine-needle aspiration can be helpful for the histological diagnosis of the tumor. The hypothesis of the association between pancreatic neoplasia and agenesis of the dorsal pancreas leads us to the suggestion that every patient with diagnosed agenesis of the dorsal pancreas should be observed with a focus on the early detection of potential malignancy.

Agenesis of the dorsal pancreas associated with mucinous cysts and chronic calcific non-alcoholic pancreatitis

Agenesis of the dorsal pancreas is a rare malformation. Since 1911 and until 2008, 107 cases have been reported. Herein we report a new case on agenesis of the dorsal pancreas associated with mucinous is and chronic calcific non-alcoholic pancreatitis.

Agenesis of the dorsal pancreas: systematic review of a clinical challenge

BACKGROUND

Agenesis of the dorsal pancreas is a rare malformation. Since 1911 and until 2008, 53 cases have been reported. Several authors have recently described the association of this anomaly with neoplasia of the ventral pancreas, thus we performed a systematic review of the literature from 2008 to 2015.

METHODS

A systematic review of the MedLine and ISI Web of Science Databases from 2008 until 2015 was carried out, and 30 articles which met the inclusion criteria were identified that included a total of 53 patients: 7 children and 46 adults.

CONCLUSIONS

Although dorsal pancreatic agenesis is a rare malformation, given its association with non-alcoholic pancreatitis and neoplasia of the residual pancreas, physicians should maintain an expectant attitude.

Neuroendocrine tumour in pancreatic dorsal agenesis: a rare association

Pancreatic dorsal agenesis (PDA) is a rare congenital anomaly, usually asymptomatic, that can present with abdominal pain, pancreatitis, diabetes mellitus and jaundice. Pancreatic tumours in PDA background are extremely rare, and when they occur are mainly pancreatic ductal adenocarcinoma. We present a case of a 48-year-old female patient with incidental detection of a 26×20 mm nodular lesion of the cephalic pancreas on ultrasound. Surgery was performed and gross examination revealed PDA with a tumour developed around the Wirsung duct. Histology showed a neuroendocrine tumour G1 with neural and vascular invasion. Two and half years later, the patient is alive and without tumour relapse. Awareness of the association of PDA and pancreatic tumours is fundamental in order to develop personalised follow-up programmes.

Agenesis of the dorsal pancreas associated with mucinous adenocarcinoma and cystic teratoma: a case report and literature review

Dorsal agenesis of the pancreas is a rare congenital anomaly. Fifty‐eight cases were reported from 1913 till 2015, nine of which were associated with tumors. We present the 10th case, the first to be associated with pancreatic mucinous adenocarcinoma and cystic teratoma, successfully managed by Whipple procedure and total pancreatectomy.

Agenesis or pseudoagenesis of the dorsal pancreas

The authors present an evidence-based case report of a patient with agenesis or pseudoagenesis of the dorsal pancreas.

Missing pancreatic isthmus during pancreaticoduodenectomy

Pancreatic malformations usually represent a surgical challenge, however, depending on the anatomical location even complex procedures such as pancreatic head resection may be facilitated. In a 78-year-old-woman the unique observation of a missing pancreatic isthmus was made during pylorus-preserving pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. Resection of the pancreatic head could be performed without the usual cross-section at the isthmus, the pancreatic remnant was drained by pancreaticogastrostomy. Complete agenesis of the dorsal pancreas with missing neck, body and tail of the pancreas has been shown to be associated with malignant pancreatic tumors, as demonstrated in this case of partial agenesis (missing isthmus) of the dorsal pancreas. The missing pancreatic isthmus is a unique, not yet described finding during pancreatic exploration for tumor resection. In the absence of previous abdominal trauma, a partial agenesis of the dorsal pancreas could explain this malformation.

Selective agenesis of pancreatic isthmus parenchyma with preservation of main pancreatic duct continuity, a very rare entity: Case report

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Pancreatic congenital anomalies are not infrequent.

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A rare selective agenesis of pancreatic parenchyma is presented.

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Neoplastic lesions should always been considered in case of pancreatic congenital anomalies.

Context

Agenesis of the dorsal pancreas is a rare anomaly, mostly associated with other medical conditions. It may be complicated with pancreatic neoplasms.

Case report

We report the case of a 51-year-old male with selective agenesis of pancreatic isthmus with preservation of main pancreatic duct and branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with suspicious features of the pancreas.

Conclusion

This is probably the first report of isolated agenesis of pancreatic isthmus with conservation of main pancreatic duct.

Giant mucinous cystic adenoma with pancreatic atrophy mimicking dorsal agenesis of the pancreas

Mucinous cystic adenoma (MCA) of the pancreas is a rare benign cystic tumor with ovarian-like stroma and lack of communication with the pancreatic ductal system. The ovarian tissue is incorporated from the left gonad within the dorsal pancreas during embryogenesis. Consequently, congenital dorsal agenesis of the pancreas (DAP) cannot be associated with MCA. We report the case of a giant MCA associated with atrophy of the dorsal pancreas mimicking complete DAP. Pancreato-magnetic resonance imaging failed to identify the dorsal pancreas but the absence of diabetes mellitus and compression of the splenic vein with major tributaries rectified the diagnosis of secondary atrophy of the distal pancreas. Unusual proximal location of the cyst in the pancreas may have induced chronic obstruction of both the dorsal pancreatic duct and the splenic vein, with secondary atrophy of the distal pancreas.

Sonographic features of agenesis of dorsal pancreas

Agenesis of dorsal pancreas is an extremely rare congenital anomaly that occurs due to failure of the dorsal pancreatic bud to form the body and tail of the pancreas. We report the sonographic appearance of this condition in six cases.

Agenesis of Dorsal Pancreas with Eventration of Diaphragm and Intrapancreatic Pseudocyst: A Rare Entity

A case of acute pancreatitis in a 43-year-old male patient, which was eventually diagnosed as agenesis of dorsal pancreas with eventration of left hemidiaphragm and intrapancreatic pseudocyst is being reported.

Dorsal agenesis of the pancreas - a rare cause of abdominal pain and insulin-dependent diabetes

Dorsal agenesis of the pancreas is a rare congenital disorder. We report a case of a 65-year-old man with mild abdominal pain and insulin-dependent diabetes mellitus. Computed tomography (CT) of the abdomen showed a short pancreas with no pancreatic tissue ventral to the splenic vein. Magnetic resonance cholangiopancreatography (MRCP) visualized the absence of a dorsal duct system and confirmed the suspicion of complete agenesis of the dorsal pancreas. Endoscopic ultrasound (EUS) was also performed to rule out pancreatic malignancy.

The novel triad of dorsal agenesis of the pancreas with concurrent pancreatic ductal adenocarcinoma and nonalcoholic chronic calcific pancreatitis: a case series and review of the literature

INTRODUCTION

Dorsal agenesis of the pancreas (DAP) is a rare congenital anomaly, with only 44 cases having been reported in the English literature since 1966.

MATERIALS AND METHODS

A retrospective review of our IRB-approved pancreatic surgery database was performed from November 2005 to November 2010 searching for cases of DAP.

DISCUSSION

Disorders in the retinoic acid (Raldh) and hedgehog (Hh) signaling pathways, which appear to play a role in the development of DAP, have been implicated in other diseases of the pancreas such as pancreatic ductal adenocarcinoma (PDA) and nonalcoholic chronic calcific pancreatitis (NCCP).

CONCLUSION

In this report, we describe three cases of DAP in the setting of PDA, two of which include the third component of NCCP. We provide a discussion of the clinical features of this novel triad and address the molecular pathways that relate to these respective diseases.