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Woo CG, Lee J, Son SM. Adenocarcinoma arising from heterotopic pancreas at the first portion of the duodenum: a case report. J Int Med Res 2023; 51:3000605231194902. [PMID: 37632411 PMCID: PMC10467418 DOI: 10.1177/03000605231194902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
Malignant transformation of a heterotopic pancreas in the duodenum is very rare. To our knowledge, only 15 cases have been reported worldwide, including the present case. We herein report a rare case of malignant transformation of a heterotopic pancreas in the duodenum along with a review of the literature.A 65-year-old man was admitted to our hospital for evaluation of dyspepsia and vomiting. Esophagogastroduodenoscopy showed a stricture of the duodenal bulb. Laparoscopic distal gastrectomy was performed. Although a duodenal tumor had not been suspected, histopathological examination of the surgical specimen showed adenocarcinoma arising from a heterotopic pancreas (Heinrich type III) in the duodenum. Four months postoperatively, the patient received adjuvant chemotherapy. He was still alive without recurrence at 24 months of follow-up.Adenocarcinoma arising in a heterotopic pancreas is rare; therefore, preoperative diagnosis is difficult to obtain. Effective management of a heterotopic pancreas depends on the presence or absence of symptoms. Awareness of the possibility of malignant change in a heterotopic pancreas of the duodenum prior to surgery is helpful for the diagnosis and appropriate management of such patients.
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Affiliation(s)
- Chang Gok Woo
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Seung-Myoung Son
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Kim JW, Kim KA, Sim KC, Lee J, Park BN, Song MJ, Park YS, Lee J, Choi JW, Lee CH. Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review. Abdom Radiol (NY) 2022; 47:2254-2276. [PMID: 35441342 DOI: 10.1007/s00261-022-03520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea.
| | - Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Bit Na Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Mi Jin Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
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3
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Tsukihara S, Onda S, Son K, Ito D, Kanno H, Morikawa T, Hanyu N, Eto K. Laparoscopic surgery for duodenal perforation due to a diverticulum with heterotopic pancreas: a case report. Surg Case Rep 2022; 8:106. [PMID: 35648320 PMCID: PMC9160170 DOI: 10.1186/s40792-022-01460-3] [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: 04/15/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) refers to the presence of abnormally located pancreatic tissue without any anatomic or vascular continuity with the main body of the pancreas. HP can occur in the gastrointestinal tract and be complicated by gastrointestinal bleeding, pancreatitis, obstruction, or malignant generation. Specifically, perforation of the gastrointestinal tract because of HP is extremely rare. CASE PRESENTATION A 91-year-old woman was diagnosed with duodenal perforation, and an emergency laparoscopic operation was performed. The operative findings indicated a tumor and duodenal wall perforation. The tumor and the perforated site were resected with a linear stapler. Histopathological examination revealed the presence of HP tissue in the submucosal layer around the diverticulum without any signs of inflammation. The perforated site was not covered by HP tissues, and the duodenal wall might have been weaker than the other areas, which could have caused the internal pressure to increase and led to the perforation. CONCLUSIONS Preoperative HP diagnosis is difficult, and it is crucial to consider HP as the differential diagnosis in gastrointestinal perforations. The duodenal diverticula can be perforated due to increased internal pressure of the duodenum caused by the imbalanced localization of HP.
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Affiliation(s)
- Shu Tsukihara
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan.
| | - Shinji Onda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Kyonsu Son
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Daisuke Ito
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Hironori Kanno
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Toshiaki Morikawa
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Nobuyoshi Hanyu
- Department of Surgery, Tokyo General Hospital, 3-15-2 Ekoda, Nakano-ku, Tokyo, 165-8906, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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A rare case of adenocarcinoma of an ectopic pancreas: A case report. Int J Surg Case Rep 2022; 94:107061. [PMID: 35413666 PMCID: PMC9018159 DOI: 10.1016/j.ijscr.2022.107061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction Ectopic pancreas refers to the presence of pancreatic tissue in an unusual anatomical location that has neither anatomic nor vascular continuity with the pancreas. Adenocarcinoma of an ectopic pancreas is rare; only few cases have been described in the literature. Presentation of case We reported a 69-year-old man who was admitted to the emergency department with feculent vomiting lasting two days prior to presentation. Endoscopy revealed pyloric stenosis. Biopsies performed during gastroscopy were in keeping with duodenal cancer, while those performed during endoscopic ultrasound suggested a gastric tumor. A subtotal gastrectomy was done because of results of the extemporaneous analysis and the suspicion of a gastric cancer. The final histopathological report revealed adenocarcinoma of an ectopic pancreas. Discussion Malignant transformation of an ectopic pancreas is very rare, and often occurs as an adenocarcinoma. A differential diagnosis of a gastric adenocarcinoma and a gastrointestinal stromal tumor is essential before treatment. Outcome and a literature review of the pathology, prognosis, and treatment will be discussed. Conclusion Despite adenocarcinoma of an ectopic pancreas being rare, it should be considered as a differential diagnosis of submucosal tumors. The standard treatment for ectopic pancreatic adenocarcinoma is surgery, with a higher survival rate of 5 years compared to pancreatic cancer. Frozen section analysis is essential because it will give an idea on the origin of the neoplasia and allow adaptation of the surgical procedure. This case report describes a case of adenocarcinoma of ectopic pancreas. Malignant transformation of the aberrant pancreas is very rare. Partial gastrectomy and duodenectomy of D1 was performed and sample sent for extemporaneous analysis. The standard treatment for ectopic pancreatic adenocarcinoma is surgery.
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Mundackal N, Arslan ME, Decker C, Lee H, Nigam A. The removal of ectopic pancreas to prevent carcinoma development. Am J Surg 2021; 222:1196-1197. [PMID: 34256929 DOI: 10.1016/j.amjsurg.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | - Hwajeong Lee
- Pathology, Albany Medical Center, Albany, NY, USA
| | - Ankesh Nigam
- Department of Surgery, Albany Medical Center, Albany, NY, USA.
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Brigmon EP, Malik MS, Malik SN, Logue A. Primary pancreatic cancer of the jejunum: a case report and brief review of literature. J Surg Case Rep 2021; 2021:rjab469. [PMID: 34703576 DOI: 10.1093/jscr/rjab469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/24/2021] [Indexed: 01/09/2023] Open
Abstract
The variable clinical presentation of heterotopic pancreatic (HP) tissue and its malignant transformation makes the diagnosis very challenging. These lesions are very rare, usually not suspected upon initial presentation and for the most part, are diagnosed incidentally on review of pathology following surgical resection. In this study, we are reporting an adenocarcinoma arising from jejunal heterotopic pancreatic tissue in a 59-year-old female and a brief review of previously reported cases.
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Affiliation(s)
- Erika P Brigmon
- Trauma and Emergency General Surgery, University of Texas, San Antonio, TX 78229 USA
| | - Mishel S Malik
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 21218 USA
| | - Shazli N Malik
- Department of Laboratories, Christus Santa Rosa Medical Center, San Antonio, TX 78229 USA
| | - Alicia Logue
- Colorectal and Minimally Invasive Surgery, University of Texas, San Antonio, TX 78229 USA
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Hirokawa YS, Iwata T, Okugawa Y, Tanaka K, Sakurai H, Watanabe M. HER2-positive adenocarcinoma arising from heterotopic pancreas tissue in the duodenum: A case report. World J Gastroenterol 2021; 27:4738-4745. [PMID: 34366633 PMCID: PMC8326258 DOI: 10.3748/wjg.v27.i28.4738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adenocarcinoma originating from heterotopic pancreas tissue is a rare disease. Furthermore, to our knowledge, no HER2-positive cases in the duodenum have been reported in the scientific literature nor has the efficacy of trastuzumab treatment for the disease been reported.
CASE SUMMARY A 65-year-old woman whose clinical diagnosis was unresectable advanced duodenal cancer with HER2 overexpression responded well to trastuzumab chemotherapy. The main tumor in the duodenum reduced drastically. The patient underwent pancreaticoduodenectomy and lymph node dissection. A small number of cancer cells remained in the submucosal layer of the duodenum and pancreas head. After histological and immunohistochemical examination, the patient was diagnosed with duodenal adenocarcinoma originating from heterotopic pancreas tissue.
CONCLUSION Trastuzumab treatment is effective in HER2-positive adenocarcinoma originating from heterotopic pancreas tissue in the duodenum.
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Affiliation(s)
- Yoshifumi S Hirokawa
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Mie 5148507, Japan
| | - Takashi Iwata
- Cancer Center, Aichi Medical University, Aichi 4801195, Japan
| | - Yoshinaga Okugawa
- Department of Genomic Medicine, Mie University Hospital, Mie 5148507, Japan
| | - Koji Tanaka
- Department of Surgery, IGA City General Hospital, Mie 5180823, Japan
| | - Hiroyuki Sakurai
- Hepato-biliary-pancreatic and Transplant Surgery, Mie University Hospital, Mie 5148507, Japan
| | - Masatoshi Watanabe
- Department of Oncologic Pathology, Mie University Graduate School of Medicine, Mie 5148507, Japan
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Cao L, Wu W, Chen D, Hong J, Wu J, Zheng S. Ileo-ileal intussusception and gastrointestinal bleeding caused by incidental heterotopic pancreas: four case reports. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:272. [PMID: 33708899 PMCID: PMC7940897 DOI: 10.21037/atm-20-2294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Heterotopic pancreas (HP) is a developmental anomaly defined as aberrantly located pancreatic tissue with no anatomical, vascular, or neural connection to the pancreas. Bowel intussusception and gastrointestinal bleeding caused by isolated HP is extremely rare. This study explores the clinical, radiographical, pathologic, and treatment features of four patients with intussusception caused by incidental HP, with the aim of providing important insight into the diagnosis and management of these patients. In this paper, the charts of four patients who underwent emergency laparotomy between January 2013 and August 2015 at the First Affiliated Hospital of Zhejiang University, China were reviewed. Patient demographics, presenting symptoms, blood test results, pre-operative imaging, operative procedure, and histopathology were retrospectively reviewed. All four patients, including three males and one female, presented to the emergency room with severe abdominal pain and melena. Routine blood tests revealed hemoglobin levels ranging from 75 to 128 g/L. Contrast-enhanced computed tomography (CT) confirmed lesions involving the ileum with intussusception and bowel obstruction, and all cases immediately underwent emergency laparotomy. All cases were subsequently diagnosed with HP according to histopathology. HP should therefore be considered as a rare but possible differential diagnosis for gastrointestinal bleeding and bowel intussusception, and as a possible cause of these conditions.
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Affiliation(s)
- Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenxuan Wu
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Diyu Chen
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawei Hong
- Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Egorov V, Petrov R, Schegolev A, Dubova E, Vankovich A, Kondratyev E, Dobriakov A, Kalinin D, Schvetz N, Poputchikova E. Pancreas-preserving duodenal resections vs pancreatoduodenectomy for groove pancreatitis. Should we revisit treatment algorithm for groove pancreatitis? World J Gastrointest Surg 2021; 13:30-49. [PMID: 33552393 PMCID: PMC7830077 DOI: 10.4240/wjgs.v13.i1.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/22/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The management of cystic dystrophy of the duodenal wall (CDDW), or groove pancreatitis (GP), remains controversial. Although pancreatoduodenectomy (PD) is considered the most suitable operation for CDDW, pancreas-preserving duodenal resection (PPDR) has also been suggested as an alternative for the pure form of GP (isolated CDDW). There are no studies comparing PD and PPDR for this disease.
AIM To compare the safety, efficacy, and short- and long-term results of PD and PPDR in patients with CDDW.
METHODS A retrospective analysis of the clinical, radiologic, pathologic, and intra- and postoperative data of 84 patients with CDDW (2004-2020) and a comparison of the safety and efficacy of PD and PPDR.
RESULTS Symptoms included abdominal pain (100%), weight loss (76%), vomiting (30%) and jaundice (18%) and data from computed tomography, magnetic resonance imaging, and endoUS led to the correct preoperative diagnosis in 98.8% of cases. Twelve patients were treated conservatively with pancreaticoenterostomy (n = 8), duodenum-preserving pancreatic head resection (n = 6), PD (n = 44) and PPDR (n = 15) without mortality. Weight gain was significantly higher after PD and PPDR and complete pain control was achieved significantly more often after PPDR (93%) and PD (84%) compared to the other treatment modalities (18%). New onset diabetes mellitus and severe exocrine insufficiency occurred after PD (31% and 14%), but not after PPDR.
CONCLUSION PPDR has similar safety and better efficacy than PD in patients with CDDW and may be the optimal procedure for the isolated form of CDDW. The pure form of GP is a duodenal disease and PD may be an overtreatment for this disease. Early detection of CDDW provides an opportunity for pancreas-preserving surgery.
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Affiliation(s)
- Vyacheslav Egorov
- Department of Surgical Oncology, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Roman Petrov
- Department of Surgical Oncology, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Aleksandr Schegolev
- V. I. Kulakov Research Center for Obstetrics, Ministry Hlth Russian Federat, VI Kulakov Res Ctr Obstet Gynecol & Perinatol, Moscow 119526, Russia
| | - Elena Dubova
- Department of Pathology, Buranazian Federal Medical and Biological Center of the Federal Medical and Biological Agency of Russian Federation, Moscow 143421, Russia
| | - Andrey Vankovich
- Department of HPB Surgery, Moscow Clinical Research Center, Moscow 111123, Russia
| | - Eugeny Kondratyev
- Department of Radiology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 143421, Russia
| | - Andrey Dobriakov
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
| | - Dmitry Kalinin
- Department of Pathology, Vishnevsky Institute of Surgery, Ilyinskaya Hospital, Moscow 117997, Russia
| | - Natalia Schvetz
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
| | - Elena Poputchikova
- Department of Pathology, Bakhrushin Brothers Moscow City Hospital, Moscow 107076, Russia
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Abstract
Background: Malignant transformation of heterotopic pancreatic tissue is a rare entity with only several case reports published in the scientific literature. Adjuvant chemotherapy following oncological resection for lesions with nodal metastasis has not been well described and there are no guidelines available to guide the management of these patients. Case Presentation: We present a case of gastric heterotopic pancreatic carcinoma with nodal metastasis in a young patient with breast cancer gene (BRCA) 2 mutation. He had undergone a laparoscopic wedge resection for a gastric lesion initially thought to be a gastrointestinal stroma tumor. Given the involvement of the wedge resection margins, the patient underwent a distal gastrectomy with oncological lymph nodal clearance. One out of the 33 harvested lymph nodes harboured micrometastasis while the main gastrectomy specimen did not have any residual malignancy. Following the histological diagnosis, he received an adjuvant chemotherapy regime akin to that prescribed for locally advanced pancreatic adenocarcinoma with good response. This is, to our knowledge, also the first such case report in a patient with BRCA2 mutation. Conclusions: Pre-operative diagnostic confirmation is challenging and endoscopic procedures pose significant false negatives. Reports of nodal metastasis following oncological resection are limited and there are no guidelines regarding adjuvant therapies. We would recommend a chemotherapy regimen similar to that for primary locally advanced pancreatic carcinoma in patients found to have nodal metastasis.
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Minami T, Terada T, Mitsui T, Nakanuma Y. Adenocarcinoma arising from a heterotopic pancreas in the first portion of the duodenum: a case report. Surg Case Rep 2020; 6:141. [PMID: 32556717 PMCID: PMC7303251 DOI: 10.1186/s40792-020-00903-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/10/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum. CASE PRESENTATION A 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumor-specific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing. CONCLUSIONS HP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended.
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Affiliation(s)
- Teruya Minami
- Department of Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan.
| | - Takuro Terada
- Department of Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Takeshi Mitsui
- Department of Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Yasuni Nakanuma
- Department of Pathology, Fukui-ken Saiseikai Hospital, Fukui, Japan
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Persano G, Cantone N, Pani E, Ciardini E, Noccioli B. Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature. Ital J Pediatr 2019; 45:142. [PMID: 31706342 PMCID: PMC6842505 DOI: 10.1186/s13052-019-0738-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Heterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding. Patients and methods The clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined. Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly. Results Fourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected. Conclusion Heterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy. Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.
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Affiliation(s)
- Giorgio Persano
- Department of Pediatric Surgery, IRCCS Gaslini, via Gerolamo Gaslini, 5, 16147, Genoa, Italy.
| | - Noemi Cantone
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Elisa Pani
- School of Pediatric Surgery, University of Genoa, Italy - Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy
| | - Enrico Ciardini
- Department of Pediatric Surgery, District Hospital, Trento, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
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BaMehriz F, Alali MN, Arishi H, Yaseen WY, Alswayyed M, Aldohayan A. Incidental Duodenal Pancreatic Heterotopia During Laparoscopic Sleeve Gastrectomy: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1305-1307. [PMID: 32152263 PMCID: PMC6730080 DOI: 10.12659/ajcr.916369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 15 Final Diagnosis: Duodenal pancreatic heterotopia Symptoms: None Medication: — Clinical Procedure: Wedge resection and primary repair Specialty: Surgery
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Affiliation(s)
- Fahad BaMehriz
- Department of General Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Mohammed N Alali
- Department of General Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Hassan Arishi
- Department of General Surgery, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affair, Riyadh, Saudi Arabia
| | - Waed Yahya Yaseen
- Department of General Surgery, AlNoor Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdullah Aldohayan
- Department of General Surgery, College of Medicine, King Saud University Medical City, King Khalid University Hospital, Riyadh, Saudi Arabia
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Kaneko T, Ohara M, Okamura K, Fujiwara-Kuroda A, Miyasaka D, Yamabuki T, Takahashi R, Komuro K, Suzuoki M, Iwashiro N, Kato M, Kimura N, Kijima H, Nakamura T, Hirano S. Adenocarcinoma arising from an ectopic pancreas in the duodenum: a case report. Surg Case Rep 2019; 5:126. [PMID: 31388774 PMCID: PMC6684697 DOI: 10.1186/s40792-019-0684-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Background The malignant transformation of an ectopic pancreas in the duodenum is extremely rare. Herein, we report a case of an adenocarcinoma that arose from an ectopic pancreas. We also reviewed 14 cases of malignant transformations arising from an ectopic pancreas in the duodenum that were previously published. Case presentation An 81-year-old man with a 1-month history of vomiting was admitted to our institution. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans revealed an obstruction at the first part of the duodenum. A distal gastrectomy was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed adenocarcinoma that arose from an ectopic pancreas (Heinrich type 1). The patient is alive without relapse at 18 months of follow-up. Conclusions Adenocarcinoma that arises from an ectopic pancreas should be considered when an obstruction is identified in the duodenum.
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Affiliation(s)
- Tsukasa Kaneko
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan.
| | - Masanori Ohara
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Kunishige Okamura
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Aki Fujiwara-Kuroda
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Daisuke Miyasaka
- Department of Surgery, Japanese Red Cross Hakodate Hospital, Hakodate, Japan
| | - Takumi Yamabuki
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Ryo Takahashi
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Kazuteru Komuro
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Masato Suzuoki
- Department of Surgery, Japanese Red Cross Hakodate Hospital, Hakodate, Japan
| | - Nozomu Iwashiro
- Department of Surgery, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Noriko Kimura
- Department of Pathology, National Hospital Organization Hakodate National Hospital, Hakodate, Japan
| | - Hiroshi Kijima
- Department of Pathology and Bioscience, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Toru Nakamura
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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15
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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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16
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Cazacu IM, Luzuriaga Chavez AA, Nogueras Gonzalez GM, Saftoiu A, Bhutani MS. Malignant Transformation of Ectopic Pancreas. Dig Dis Sci 2019; 64:655-668. [PMID: 30415408 DOI: 10.1007/s10620-018-5366-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
Malignant transformation of ectopic pancreas tissue is a diagnostic challenge as clinical symptoms and radiographic features of these tumors are non-specific. Given the rarity of these lesions, it is usually neither suspected nor included in the diagnostic workup of different tumors. We conducted a comprehensive literature review regarding malignancy arising from ectopic pancreas for a better understanding of its frequency, clinicopathological features, and prognosis. A literature search was performed in three major databases: PubMed, Cochrane, and Web of Science. Fifty-four well-documented cases of malignant ectopic pancreas were identified in the published literature. Our analysis provided the following observations: (1) there was a slight predominance of males over females; (2) most patients with malignant transformation of ectopic pancreas were middle-aged; (3) most commonly, the tumor was located in the stomach; (4) most tumors were adenocarcinomas; (5) most frequently, the malignancy arose within a type I heterotopia according to Heinrich classification; (6) macroscopically, a subepithelial-like appearance was most frequently observed; and (7) improved prognosis for ectopic pancreatic malignancies in comparison with reported survival data for orthotopic pancreatic cancer. Even if the majority of cases of ectopic pancreas are incidental findings and malignant transformation is a rare event, pancreatic heterotopy should be considered as a source of potentially malignant lesions.
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Affiliation(s)
- Irina M Cazacu
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adriana Alexandra Luzuriaga Chavez
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Graciela M Nogueras Gonzalez
- Department of Biomathematics and Biostatistics, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 66 1 Mai Blvd., 200638, Craiova, Romania
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA.
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17
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Chin KM, Tan DMY, Chan NHL, Goh BKP. Successful preoperative diagnosis of heterotopic pancreas in the duodenum. Int J Surg Case Rep 2019; 55:125-128. [PMID: 30735965 PMCID: PMC6365385 DOI: 10.1016/j.ijscr.2019.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
HP mostly occurs in the alimentary tract, with a predilection for the stomach and duodenum. Radiological features of HP include endoluminal growth pattern, ill-defined borders, enhancement of overlying mucosa. Endoscopic features of HP include lobulated margins, anechoeic ductal structures and central umbilication. Management of HP is controversial and commonly delayed due to diagnostic dilemma.
Introduction Heterotopic pancreas (HP) is a relatively rare entity occurring in approximately 5% of the general population. It most commonly presents as an asymptomatic mass incidentally picked up on unrelated scans. HP most commonly occurs intra-abdominally, but has been known to occur in extra-abdominal sites such as the lung and brain. It is widely considered to bear little to no malignant potential. Difficulty and ambiguity in the diagnosis of HP commonly results in interventional dilemma and delay. Presentation of case We present a case of uncomplicated HP that was ultimately treated conservatively. Discussion A literature review is made of the typical workup in a patient with suspected HP, and the characteristic radiological and endoscopic findings commonly used for diagnosis of this rare condition. A succinct summary of management guidelines for HP is reviewed. Conclusion HP is most commonly an incidental finding. Ambiguity surrounding its diagnosis commonly gives rise to interventional dilemma and delay. The gold standard for diagnosis remains that of EUS and FNA with histological confirmation. This report has been written in concordance with the SCARE criteria Agha et al. [1].
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Affiliation(s)
- Ken Min Chin
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore.
| | - Damien M Y Tan
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Norman H L Chan
- Department of Pathology, Singapore General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore (NUS) Medical School, Singapore.
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18
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Abstract
The pancreas is a complex organ that may give rise to large number of neoplasms and non-neoplastic lesions. This article focuses on benign neoplasms, such as serous neoplasms, and tumorlike (pseudotumoral) lesions that may be mistaken for neoplasm not only by clinicians and radiologists, but also by pathologists. The family of pancreatic pseudotumors, by a loosely defined conception of that term, includes a variety of lesions including heterotopia, hamartoma, and lipomatous pseudohypertrophy. Autoimmune pancreatitis and paraduodenal ("groove") pancreatitis may also lead to pseudotumor formation. Knowledge of these entities will help in making an accurate diagnosis.
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Affiliation(s)
- Olca Basturk
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Gokce Askan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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19
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Kotlyarov PM. Magnetic resonance imaging in recognition of ectopic pancreatic tissue (Clinical observation). TERAPEVT ARKH 2018; 90:94-97. [DOI: 10.26442/terarkh201890294-97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A rare clinical observation of retroperitoneal ectopy of pancreatic tissue with diligence to the kidney and jejunum is presented. For the first time, semiotics of ectopia is described according to the data of magnetic resonance imaging, which allows to determine with a high degree of reliability the belonging of the revealed structures to the tissues of the pancreas.
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20
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Fujita N, Tambo M, Terado Y, Fujita M, Okegawa T, Nutahara K. Vesicoenteric Fistula Arising from an Adenocarcinoma of Ectopic Pancreatic Tissue in a Meckel Diverticulum. Case Rep Oncol 2018. [PMID: 29515402 PMCID: PMC5836225 DOI: 10.1159/000485458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report a case of a vesicoenteric fistula arising from an adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum in a 58-year-old man. The patient suffered from refractory micturition pain and increased urinary frequency. Computerized tomography with a contrast agent showed a ring-shaped enhanced mass near the dome of the urinary bladder. Magnetic resonance imaging showed a cystic mass close to the urinary bladder with partly irregular wall and fistula formation to the urinary bladder. Surgical findings showed a Meckel diverticulum in the ileum, which formed a fistula with the urinary bladder, and Meckel diverticulectomy and partial cystectomy were performed. Histological findings revealed a vesicoenteric fistula arising from a papillary adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum. The patient has survived without recurrence for more than 4 years since surgery.
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Affiliation(s)
- Naoyuki Fujita
- aDepartment of Urology, Kyorin University School of Medicine, Mitaka, Japan
| | - Mitsuhiro Tambo
- aDepartment of Urology, Kyorin University School of Medicine, Mitaka, Japan
| | - Yuichi Terado
- bDepartment of Pathology, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Michio Fujita
- cDepartment of Urology, Fujita Clinic, Funabashi, Japan
| | - Takatsugu Okegawa
- aDepartment of Urology, Kyorin University School of Medicine, Mitaka, Japan
| | - Kikuo Nutahara
- aDepartment of Urology, Kyorin University School of Medicine, Mitaka, Japan
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21
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Rezvani M, Menias C, Sandrasegaran K, Olpin JD, Elsayes KM, Shaaban AM. Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications. Radiographics 2017; 37:484-499. [PMID: 28287935 DOI: 10.1148/rg.2017160091] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Heterotopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separate from the main gland. The most common locations of this displacement include the upper gastrointestinal tract-specifically, the stomach, duodenum, and proximal jejunum. Less common sites are the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Uncomplicated heterotopic pancreas is typically asymptomatic, with the lesion being discovered incidentally during an unrelated surgery, during an imaging examination, or at autopsy. The most common computed tomographic appearance of heterotopic pancreas is that of a small oval intramural mass with microlobulated margins and an endoluminal growth pattern. The attenuation and enhancement characteristics of these lesions parallel their histologic composition. Acinus-dominant lesions demonstrate avid homogeneous enhancement after intravenous contrast material administration, whereas duct-dominant lesions are hypovascular and heterogeneous. At magnetic resonance imaging, the heterotopic pancreas is isointense to the orthotopic pancreas, with characteristic T1 hyperintensity and early avid enhancement after intravenous gadolinium-based contrast material administration. Heterotopic pancreatic tissue has a rudimentary ductal system in which an orifice is sometimes visible at imaging as a central umbilication of the lesion. Complications of heterotopic pancreas include pancreatitis, pseudocyst formation, malignant degeneration, gastrointestinal bleeding, bowel obstruction, and intussusception. Certain complications may be erroneously diagnosed as malignancy. Paraduodenal pancreatitis is thought to be due to cystic degeneration of heterotopic pancreatic tissue in the medial wall of the duodenum. Recognizing the characteristic imaging features of heterotopic pancreas aids in differentiating it from cancer and thus in avoiding unnecessary surgery. © RSNA, 2017.
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Affiliation(s)
- Maryam Rezvani
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Christine Menias
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Kumaresan Sandrasegaran
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Jeffrey D Olpin
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Khaled M Elsayes
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
| | - Akram M Shaaban
- From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.)
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22
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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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23
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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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24
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Zhang Y, Sun X, Gold JS, Sun Q, Lv Y, Li Q, Huang Q. Heterotopic pancreas: a clinicopathological study of 184 cases from a single high-volume medical center in China. Hum Pathol 2016; 55:135-42. [PMID: 27195908 DOI: 10.1016/j.humpath.2016.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/18/2016] [Accepted: 05/05/2016] [Indexed: 12/18/2022]
Abstract
Heterotopic pancreas (HP) is often an incidental finding during operative or endoscopic procedures and described in case reports and small series in the literature. Large clinicopathological studies with a systematic analysis remain lacking. Herein, we identified 184 (0.18%; 184/99 544) consecutive histology-proven HP cases of 89 770 surgical resections and 9774 upper endoscopic biopsies carried out at a single medical center in China. Each case was diagnosed by unequivocal identification of pancreatic acini at a location outside the pancreas. The patients' median age was 49 years (range, 14-82) with a slight female predominance (male/female ratio, 0.94). Clinical presentation at diagnosis was nonspecific. Preoperatively, most (54.9%; 101/184) HP lesions were misdiagnosed. Only 26 HP lesions (14.1%) were correctly diagnosed, all in the stomach except for 1 in the duodenum; 57 (31%) were detected during operative procedures for other conditions. The most frequent location of HP was, in descending order, the stomach (97; 52.7%), small intestine (48; 26%), lesser and greater curvature omentum (18; 10%), spleen and hilar region (5; 2.7%), porta hepatis (2; 1%), gallbladder (1; 0.5%), peridistal esophageal tissue (4; 2.2%), and mesentery (7; 3.8%). The size of HP varied from smaller than 0.5 cm (35.3%), 0.6 to 1 cm (34.8%), to larger than 1.1 cm (29.9%). Because of difficulty in preoperative diagnosis, careful workup for upper gastrointestinal diseases with HP as a differential diagnosis may increase the chance of accurate diagnosis and appropriate patient management.
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Affiliation(s)
- Yifen Zhang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Xitai Sun
- Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Jason S Gold
- Department of Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132
| | - Qi Sun
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Ying Lv
- Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Qiang Li
- Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China
| | - Qin Huang
- Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China; Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132.
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25
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Yamaoka Y, Yamaguchi T, Kinugasa Y, Shiomi A, Kagawa H, Yamakawa Y, Numata M, Sugimoto S, Imai K, Hotta K, Sasaki K. Adenocarcinoma arising from jejunal ectopic pancreas mimicking peritoneal metastasis from colon cancer: a case report and literature review. Surg Case Rep 2015; 1:114. [PMID: 26943438 PMCID: PMC4648850 DOI: 10.1186/s40792-015-0118-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/03/2015] [Indexed: 02/06/2023] Open
Abstract
Adenocarcinoma arising from jejunal ectopic pancreas is very rare. We report a case of a 69-year-old female with adenocarcinoma arising from jejunal ectopic pancreas after resection of advanced colon cancer. She underwent right hemicolectomy for advanced ascending colon cancer (ypT3N0M0, stage IIA) after chemotherapy. Two and half years after colectomy, her tumor markers were elevated, and computed tomography revealed a mass measuring 20 × 20 mm in the small intestine, having an abnormal uptake of 18F-fluorodeoxyglucose on 18F-fluorodeoxyglucose-positron emission tomography (18FDG-PET). Double-balloon enteroscopy revealed a submucosal tumor in the jejunum, and histopathology of biopsy specimens from that lesion showed ectopic pancreas without malignancy. Therefore, peritoneal metastasis from colon cancer concomitant with ectopic pancreas or adenocarcinoma arising from ectopic pancreas was considered as a differential diagnosis. She underwent laparoscopic jejunectomy. Pathological examination revealed a moderately differentiated adenocarcinoma arising from jejunal ectopic pancreas, not peritoneal metastasis from colon cancer. Even if histopathology of the biopsy specimen shows ectopic pancreas without malignancy, adenocarcinoma arising from ectopic pancreas should be considered when the tumor markers are elevated or the lesion has an abnormal uptake of 18FDG.
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Affiliation(s)
- Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yusuke Kinugasa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Yushi Yamakawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Masakatsu Numata
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Shinya Sugimoto
- Division of Endoscopy, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
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