1
|
Farho MA, Alrawi M, Mobaid M, Kudsi MA, Hendi H, Ghazal A. Ectopic pancreas in a 16-year-old male during bariatric surgery: A rare case in the medical literature. Int J Surg Case Rep 2024; 118:109613. [PMID: 38608520 PMCID: PMC11024645 DOI: 10.1016/j.ijscr.2024.109613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Obesity is a global epidemic, and bariatric surgery is an effective treatment. During this surgery, rare abnormalities in the small intestine, like ectopic pancreas (EP), can be found. CASE PRESENTATION A 16-year-old male presented at the surgical clinic with a complaint of morbid obesity, weighing 140 KG. Since he was unable to commit to a diet, bariatric surgery was performed. During the surgery, the gastrointestinal tract was examined, and an incidental finding was noted in the wall of the proximal jejunum. The histopathology report revealed that the excisional biopsy was a complete EP in the proximal jejunum. The patient was discharged from the hospital on the first postoperative day, and his condition remained stable. CLINICAL DISCUSSION Our case of EP stood out due to its larger size, measuring 3.5 cm in diameter, while EP lesions are typically smaller, despite its size, the patient did not experience any symptoms. EP is more commonly found in individuals between 40 and 50 years old, with a higher incidence in males. However, our patient is only 16 years old. CONCLUSION Surgical resection is the most effective treatment, preventing malignant transformation and future complications. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature.
Collapse
Affiliation(s)
- Mohamad Ali Farho
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Mawya Alrawi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic.
| | - Maram Mobaid
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | | | - Hamza Hendi
- Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
| | - Ahmad Ghazal
- Department of General Surgery, Aleppo University Hospital, University of Aleppo, Aleppo, Syrian Arab Republic
| |
Collapse
|
2
|
Sun K, Yu S, Wang Y, Jia R, Shi R, Liang C, Wang X, Wang H. Development of a multi-phase CT-based radiomics model to differentiate heterotopic pancreas from gastrointestinal stromal tumor. BMC Med Imaging 2024; 24:44. [PMID: 38355484 PMCID: PMC10868069 DOI: 10.1186/s12880-024-01219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND To investigate whether CT-based radiomics can effectively differentiate between heterotopic pancreas (HP) and gastrointestinal stromal tumor (GIST), and whether different resampling methods can affect the model's performance. METHODS Multi-phase CT radiological data were retrospectively collected from 94 patients. Of these, 40 with HP and 54 with GISTs were enrolled between April 2017 and November 2021. One experienced radiologist manually delineated the volume of interest and then resampled the voxel size of the images to 0.5 × 0.5 × 0.5 mm3, 1 × 1 × 1 mm3, and 2 × 2 × 2 mm3, respectively. Radiomics features were extracted using PyRadiomics, resulting in 1218 features from each phase image. The datasets were randomly divided into training set (n = 66) and validation set (n = 28) at a 7:3 ratio. After applying multiple feature selection methods, the optimal features were screened. Radial basis kernel function-based support vector machine (RBF-SVM) was used as the classifier, and model performance was evaluated using the area under the receiver operating curve (AUC) analysis, as well as accuracy, sensitivity, and specificity. RESULTS The combined phase model performed better than the other phase models, and the resampling method of 0.5 × 0.5 × 0.5 mm3 achieved the highest performance with an AUC of 0.953 (0.881-1), accuracy of 0.929, sensitivity of 0.938, and specificity of 0.917 in the validation set. The Delong test showed no significant difference in AUCs among the three resampling methods, with p > 0.05. CONCLUSIONS Radiomics can effectively differentiate between HP and GISTs on CT images, and the diagnostic performance of radiomics is minimally affected by different resampling methods.
Collapse
Affiliation(s)
- Kui Sun
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Shuxia Yu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, No. 324, 250021, Jinan, China
| | - Ying Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China
| | - Rongze Jia
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong Provincial Hospital of Traditional Chinese Medicine, Jing Shi Road, No. 16369, 250014, Jinan, China
| | - Rongchao Shi
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jing Wu Road, No. 324, 250021, Jinan, China
| | - Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
| | - Haiyan Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
| |
Collapse
|
3
|
Sakurai Y, Togasaki K, Nakamura Y, Fukuda H, Karaki H, Okaya T, Hirai F, Abe M, Sugano I. Gastric type III heterotopic pancreas presenting as adenomyoma in the antrum of the stomach: a case report. Clin J Gastroenterol 2024; 17:34-40. [PMID: 37831374 DOI: 10.1007/s12328-023-01872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023]
Abstract
Although heterotopic pancreas usually occurs in the stomach and rarely presents as a submucosal tumor, an accurate preoperative diagnosis is often difficult because of the variety of clinical symptoms and findings depending on the size and location of the lesion. We experienced a case of gastric type III heterotopic pancreas presenting as a gastric adenomyoma in the antrum of the stomach. A 62-year-old woman visited a local hospital for epigastric discomfort. An esophagogastroduodenoscopy study indicated a submucosal tumor in the greater curvature of the gastric antrum. The patient underwent surgical resection of the tumor because it was enlarged. The histological sections of the resected specimen showed that the tumor was composed of ductular structures lined by tall columnar epithelia and a prominent smooth muscle stroma with no atypical cells. The tumor was compatible with Heinrich's type III heterotopic pancreas, which presented as an adenomyoma of the stomach. These findings provide useful histological features and some insight into a better understanding of the embryonic origin and development of adenomyoma and heterotopic pancreas in the antrum of the stomach.
Collapse
Affiliation(s)
- Yoichi Sakurai
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan.
| | - Kentaro Togasaki
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan
| | - Yusuke Nakamura
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan
| | - Hiroyuki Fukuda
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan
| | - Hirokazu Karaki
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan
| | - Tomohisa Okaya
- Department of Surgery, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, 1-Chome 1-1 Izumi-cho, Narashino, Chiba, 275-8580, Japan
| | - Futoshi Hirai
- Department of Gastroenterology, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Chiba, Japan
| | - Michikazu Abe
- Department of Gastroenterology, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Chiba, Japan
| | - Isamu Sugano
- Pathology Division, Chiba-Ken Saiseikai Narashino Hospital, Social Welfare Organization, Saiseikai Imperial Gift Foundation, Chiba, Japan
| |
Collapse
|
4
|
Yi DF, Yang Q, Zhang P. A case report of adrenal heterotopic pancreas. Asian J Surg 2023; 46:5964-5965. [PMID: 37704481 DOI: 10.1016/j.asjsur.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Dong-Feng Yi
- Department of Urology, Lichuan People's Hospital, Lichuan, China
| | - Qian Yang
- Department of Gastroenterology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Peng Zhang
- Department of Urology, Guizhou Provincial People's Hospital, Guiyang, China.
| |
Collapse
|
5
|
Feng N, Chen HY, Wang XJ, Lu YF, Zhou JP, Zhou QM, Wang XB, Yu JN, Yu RS, Xu JX. A CT-based nomogram established for differentiating gastrointestinal heterotopic pancreas from gastrointestinal stromal tumor: compared with a machine-learning model. BMC Med Imaging 2023; 23:131. [PMID: 37715139 PMCID: PMC10504714 DOI: 10.1186/s12880-023-01094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To identify CT features and establish a nomogram, compared with a machine learning-based model for distinguishing gastrointestinal heterotopic pancreas (HP) from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS This retrospective study included 148 patients with pathologically confirmed HP (n = 48) and GIST (n = 100) in the stomach or small intestine that were less than 3 cm in size. Clinical information and CT characteristics were collected. A nomogram on account of lasso regression and multivariate logistic regression, and a RandomForest (RF) model based on significant variables in univariate analyses were established. Receiver operating characteristic (ROC) curve, mean area under the curve (AUC), calibration curve and decision curve analysis (DCA) were carried out to evaluate and compare the diagnostic ability of models. RESULTS The nomogram identified five CT features as independent predictors of HP diagnosis: age, location, LD/SD ratio, duct-like structure, and HU lesion/pancreas A. Five features were included in RF model and ranked according to their relevance to the differential diagnosis: LD/SD ratio, HU lesion/pancreas A, location, peritumoral hypodensity line and age. The nomogram and RF model yielded AUC of 0.951 (95% CI: 0.842-0.993) and 0.894 (95% CI: 0.766-0.966), respectively. The DeLong test found no statistically significant difference in diagnostic performance (p > 0.05), but DCA revealed that the nomogram surpassed the RF model in clinical usefulness. CONCLUSION Two diagnostic prediction models based on a nomogram as well as RF method were reliable and easy-to-use for distinguishing between HP and GIST, which might also assist treatment planning.
Collapse
Affiliation(s)
- Na Feng
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Hai-Yan Chen
- Department of Radiology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, 310022, Hangzhou, Zhejiang, China
| | - Xiao-Jie Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Yuan-Fei Lu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Jia-Ping Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Qiao-Mei Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Xin-Bin Wang
- Department of Radiology, The First People's Hospital of Xiaoshan District, Hangzhou, China
| | - Jie-Ni Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China
| | - Ri-Sheng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Road 88#, 310009, Hangzhou, China.
| | - Jian-Xia Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang Chinese Medical University, Chaowang Road 318#, 310005, Hangzhou, China.
| |
Collapse
|
6
|
McCarthy C, Ware A, Redan JA. Jejunal Intussusception Secondary to Pancreatic and Gastric Heterotopia in a 23-Year-Old. CRSLS 2023; 10:e2023.00018. [PMID: 37671367 PMCID: PMC10476238 DOI: 10.4293/crsls.2023.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Introduction Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception. Case Description This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms. Discussion Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.
Collapse
Affiliation(s)
- Caline McCarthy
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Amendha Ware
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| | - Jay A Redan
- Department of Surgery, AdventHealth-Celebration Health, Celebration, FL, USA
| |
Collapse
|
7
|
Huang JH, Guo W, Liu Z. Intraductal papillary mucinous neoplasm originating from a jejunal heterotopic pancreas: A case report. World J Clin Cases 2023; 11:2496-2501. [PMID: 37123302 PMCID: PMC10131005 DOI: 10.12998/wjcc.v11.i11.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic tumor and has the potential to become malignant. Surgery is the most effective treatment at present, but there is no consensus on the site of resection. Heterotopic pancreas occurs in the gastrointestinal tract, especially the stomach and duodenum but is asymptomatic and rare. We report a case of ectopic pancreas with IPMN located in the jejunum.
CASE SUMMARY A 56-year-old male patient suffered from severe pain, nausea and vomiting due to a traffic accident and sought emergency treatment at our hospital. Contrast-enhanced computed tomography of the whole abdomen suggested splenic congestion, which was considered to be splenic rupture. Emergency laparotomy was performed, and the ruptured spleen was removed during the operation. Unexpectedly, a cauliflower-like mass of about 2.5 cm × 2.5 cm in size was incidentally found about 80 cm from the ligament of Treitz during the operation. A partial small bowel resection was performed, and postoperative pathology confirmed the small bowel mass as heterotopic pancreas with low-grade IPMN.
CONCLUSION Ectopic pancreas occurs in the jejunum and is pathologically confirmed as IPMN after surgical resection.
Collapse
Affiliation(s)
- Jun-Hao Huang
- Department of Pancreatic-Biliary Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wei Guo
- Department of Pancreatic-Biliary Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Zhe Liu
- Department of Pancreatic-Biliary Surgery, The First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| |
Collapse
|
8
|
Mirzaie S, Hu TX, Yang L, Lawson KL, Girgis MD. Gastric outlet obstruction caused by heterotopic pancreas in a patient with alcohol use disorder. Int J Surg Case Rep 2023; 105:107974. [PMID: 36933407 PMCID: PMC10034423 DOI: 10.1016/j.ijscr.2023.107974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Heterotopic Pancreas (HP) is defined by the presence of pancreatic tissue in an anatomically distinct location from the main pancreas. While often clinically silent, it may present symptomatically. If located in the gastric antrum, HP may cause gastric outlet obstruction (GOO). The objective of this paper is to present a rare case of HP in the gastric antrum causing GOO. CASE PRESENTATION Herein, we report a 43-year-old man who presented with abdominal pain and non-bilious emesis in the setting of COVID-19 infection and alcohol consumption. During the initial workup, computed-tomography (CT) was non-specific but demonstrated GOO, concerning for cancer. Cold forceps biopsies taken during esophagogastroduodenoscopy (EGD) confirmed benign HP. Since the patient was symptomatic from gastric outlet compression, he underwent resection via laparoscopic distal gastrectomy and Billroth II gastrojejunostomy. At 1-month postoperative follow-up, the patient recovered uneventfully. We hypothesized that GOO by HP in this case may have been associated with cumulative effects of alcohol consumption and COVID-19 infection on the ectopic tissue. CLINICAL DISCUSSION HP is rare and difficult to diagnose preoperatively. When located in gastric antrum, HP can cause GOO, mimicking gastric malignancy. Combination of EGD/EUS, biopsy/FNA, and surgical resection are necessary to definitively make the diagnosis. Finally, it is important to consider that heterotopic pancreatitis or structural changes in HP may occur due to classic pancreatic stressors like alcohol and viral infections. CONCLUSION HP may cause GOO presenting with non-bilious emesis and abdominal pain, mistaken for malignancy on CT imaging.
Collapse
Affiliation(s)
- Sarah Mirzaie
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA.
| | - Theodore X Hu
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA
| | - Lu Yang
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA
| | - Katy L Lawson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine and Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA 90095, USA
| | - Mark D Girgis
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA; David Geffen School of Medicine, University of California at Los Angeles, Department of Surgery, Los Angeles, CA, USA
| |
Collapse
|
9
|
Braga M, Matos AP, Marques PP, Ramalho M. Gastric ectopic pancreas in magnetic resonance imaging: A review of 2 cases. Radiol Case Rep 2023; 18:1181-1185. [PMID: 36660566 PMCID: PMC9842967 DOI: 10.1016/j.radcr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.
Collapse
Affiliation(s)
- Miguel Braga
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Corresponding author.
| | - António P. Matos
- Department of Radiology, Hospital CUF Tejo, Av. 24 de Julho 171A, 1350-352, Lisbon, Portugal
| | - Pedro Pinto Marques
- Department of Gastroenterology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
- Department of Radiology, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisbon, Portugal
| |
Collapse
|
10
|
Carey K, Makiewicz K, Sarran M, Torquati A, Bonomo S. Two Cases of Heterotopic Pancreas of the Small Bowel Incidentally Found During Laparoscopic Bariatric Surgery. CRSLS 2022; 9:e2022.00052. [PMID: 36452881 PMCID: PMC9673994 DOI: 10.4293/crsls.2022.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND We present two cases of incidentally found heterotopic pancreas during laparoscopic bariatric surgery. Heterotopic pancreas is a rare congenital anomaly where pancreatic tissue is located outside of the pancreas. These lesions may be encountered incidentally during surgery, which raise unexpected management questions. CASE 1 A single pathology confirmed ectopic pancreas lesion encountered in the jejunem during laparoscopic Roux-en Y gastric bypass. CASE 2 Two pathology confirmed heterotopic pancreas lesions encountered in the jejunem during laparoscopic Roux-en Y gastric bypass. DISCUSSION Heterotopic pancreas lesions are generally benign and encountered incidentally during intra-abdominal surgery. Surgeons must decide whether to resect the incidentally found mass. When encountered intraoperatively, a heterotopic pancreas lesion found in the small bowel without concerning features should be considered benign and does not warrant resection or biopsy.
Collapse
Affiliation(s)
- Kyle Carey
- Department of General Surgery, Rush University Medical Center, Chicago, IL
- Department of General Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Kristine Makiewicz
- Department of General Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| | - Marc Sarran
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- Department of General Surgery, Rush University Medical Center, Chicago, IL
| | - Steven Bonomo
- Department of General Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, IL
| |
Collapse
|
11
|
Pham NTT, Nguyen ANT, Vo MTT, Pham MD. Heterotopic Pancreas in the Duodenum Diagnosed after Laparoscopic Biopsy. Case Rep Gastroenterol 2022; 16:546-551. [PMID: 36824699 PMCID: PMC9941766 DOI: 10.1159/000526135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/15/2022] [Indexed: 11/19/2022] Open
Abstract
Heterotopic pancreas is defined as the presence of ectopic pancreatic tissue outside boundaries of the pancreas without vascular and duct system connection with the pancreas. Ectopic locations are mostly found anywhere in the gastrointestinal tract such as the stomach (24-38%), the duodenum (9-36%), and the jejunum (0.5-27%). Clinical manifestations are not specific, vague, and misdiagnosed another digestive disease. Most cases are incidentally detected by histological examination of specimens resected for different pathologies during endoscopy, surgery, or even autopsy. We report a case of a 31-year-old man who admitted to the hospital with the reason of epigastric pain for 3 days. Clinical examination showed mild epigastric tenderness. The past medical history of patient was unremarkable. A submucosal lesion was observed in the first part of the duodenum during endoscopy. Computed tomography and endoscopic ultrasonography findings were suspected to be heterotopic pancreatic tissue. After laparoscopic surgery for biopsy, it was histologically confirmed duodenal ectopic pancreas. It is difficult to differentiate gastrointestinal pancreatic heterotopia from gastrointestinal stromal tumors, leiomyoma, or lymphomas by using endoscopy because ectopic tissue is mostly located in the submucosal layer. In addition, rare cases of ectopic pancreatic tissue transform malignancy. Surgical treatment should be considered to take adequate tissue samples for biopsy or resect the lesions in symptomatic patients. Duodenal pancreatic heterotopia is an uncommon congenital malformation and most patients are asymptomatic. Histological examination is essential to exclude malignant lesions and to have an appropriate treatment.
Collapse
Affiliation(s)
- Ngoc Trinh Thi Pham
- aSchool of Medicine and Pharmacy, The University of Danang, Da Nang, Vietnam
| | | | - Minh Tri Thi Vo
- aSchool of Medicine and Pharmacy, The University of Danang, Da Nang, Vietnam
| | - Minh Duc Pham
- bDepartment of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam,cDepartment of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue, Vietnam,*Minh Duc Pham,
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
13
|
LeCompte MT, Mason B, Robbins KJ, Yano M, Chatterjee D, Fields RC, Strasberg SM, Hawkins WG. Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum: A case series and systematic literature review. World J Gastroenterol 2022; 28:1455-1478. [PMID: 35582670 PMCID: PMC9048474 DOI: 10.3748/wjg.v28.i14.1455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/11/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract. While the majority of heterotopic pancreatic lesions are asymptomatic, many manifest severe clinical symptoms which require surgical or endoscopic intervention. Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature. The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.
AIM To classify the common clinical manifestations of heterotopic pancreas.
METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018. Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location. Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated. These were compared to a systematic review of the literature utilizing PubMed and Embase searches for papers pertaining to heterotopic pancreas. Publications describing symptomatic presentation of HP were selected for review. Information including demographics, symptoms, presentation and treatment were compiled and analyzed.
RESULTS Twenty-nine patient were identified with HP at a single center, with six of these identified has having clinical symptoms. Clinical manifestations included, gastrointestinal bleeding, gastric ulceration with/without perforation, pancreatitis, and gastric outlet obstruction. Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients. Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients. The majority of patients presented with abdominal pain (67%) combined with one of the following clinical categories: (1) Dyspepsia, (n = 445, 48%); (2) Pancreatitis (n = 260, 28%); (3) Gastrointestinal bleeding (n = 80, 9%); and (4) Gastric outlet obstruction (n = 80, 9%). The majority of cases (n = 832, 90%) underwent surgical or endoscopic resection with 85% reporting resolution or improvement in their symptoms.
CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract. Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.
Collapse
Affiliation(s)
- Michael T LeCompte
- Department of Surgical Oncology, University of North Carolina, Raleigh, NC 27608, United States
| | - Brandon Mason
- Department of Radiology, Stillwater Medical Center, Stillwater, OK 74074, United States
| | - Keenan J Robbins
- Department of General Surgery, Washington University St. Louis, St. Louis, MO 63110-8109, United States
| | - Motoyo Yano
- Department of Radiology, Mayo Clinic, Phoenix, AZ 8505, United States
| | - Deyali Chatterjee
- Department of Pathology and Immunology, MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Ryan C Fields
- Department of Surgical Oncology, Washington University School of Medicine, St. Louis, MO 63110-8109, United States
| | - Steven M Strasberg
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
| | - William G Hawkins
- Section of Hepatobiliary-Pancreatic and GI Surgery, Washington University St. Louis, St. Louis, MO 63110, United States
| |
Collapse
|
14
|
Jun SY, Chun J, Kim SJ, Oh D, Kim JH, Kim MH, Hong SM. Granulocytic epithelial lesion (GEL) in heterotopic pancreas. Pancreatology 2022; 22:435-442. [PMID: 35283009 DOI: 10.1016/j.pan.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/21/2022] [Accepted: 03/02/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The diagnosis of type 2 autoimmune pancreatitis (AIP) is dependent on typical radiologic imaging and the presence of the granulocytic epithelial lesion (GEL), which is characterized by ductal neutrophilic infiltration with or without neutrophilic acinar infiltration. METHODS We evaluated GEL and related clinicopathologic factors in 165 resected heterotopic pancreata (HPs) [57 gastric (35%), 56 duodenal (34%), 30 omental (18%), and 22 jejunal (13%)] and 29 matched orthotopic pancreata routinely examined during surgery. RESULTS GEL was noted in 8% (13/165) of HPs, including ductal epithelial (6/13, 46%) and intraluminal (8/13, 62%) neutrophilic infiltrations. However, there was no GEL in orthotopic pancreata. Abdominal pain was observed in 6 (46%) patients with GEL-positive HPs. GEL was more commonly observed in HPs having symptoms (p = 0.029), a larger size (p = 0.028), and an infiltrative growth pattern (p = 0.006). In addition, periductal lymphoplasmacytic infiltration and fibrosis (both p < 0.001), interstitial fibrosis (p = 0.017), acinar neutrophilic infiltration (p = 0.032), venulitis (p = 0.050), acinar ductal metaplasia (ADM; p = 0.040), and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; p < 0.001) were more commonly seen in HPs with GEL than in those without GEL. Inflammatory bowel disease was present only in one patient with GEL-negative HP. CONCLUSIONS GELs are detected in a subset of HPs without clinical evidence of AIP. Therefore, for the diagnosis of AIP, GEL should be carefully interpreted with the context of other histologic, clinical, and radiologic findings.
Collapse
Affiliation(s)
- Sun-Young Jun
- Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyun Chun
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Joo Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dongwook Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung-Hwan Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Mo Hong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
15
|
Bejiga G. Gastric outlet obstruction secondary to heterotopic pancreas being mistaken for gastric cancer: "Case report". Int J Surg Case Rep 2022; 93:106974. [PMID: 35367947 PMCID: PMC8980623 DOI: 10.1016/j.ijscr.2022.106974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Heterotopic pancreas (HP) is an uncommon and often incidental finding in clinical practice. It is the presence of pancreatic tissue distinct from the normal pancreas and with its own ductal and vascular supply. Distal stomach is the most common location of heterotopic pancreas followed by duodenum and jejunum. Most patients with heterotopic pancreas are asymptomatic. Gastric outlet obstruction is a rare presentation of heterotopic pancreas that can follow chronic inflammation and fibrosis of the pylorus from pancreatic secretion, pancreatitis, or malignant transformation. Heterotopic pancreas can be confused for gastric carcinomas on CECT and endoscopy. The aim of this paper is to present a rare case of gastric outlet obstruction due to heterotopic pancreas, mistaken for gastric cancer on endoscopy and CT scan, and its management. PRESENTATION OF THE CASE A 45 years old male from Adama, Ethiopia presented with vomiting of 8 months, which worsened since the last one month. He has no history of smoking and diabetes. He occasionally drinks alcohol. Physical examination was normal. CECT scan and endoscopy suggested distal gastric cancer. Radical subtotal gastrectomy done as gastric cancer couldn't be ruled out with excellent outcome. Histopathology revealed obstructing prepyloric chronic fibrosis and heterotopic pancreas. DISCUSSION Heterotopic pancreas is a rare pathological entity, clinical diagnosis is difficult preoperatively and frequently an incidental finding at laparotomy. CONCLUSION Though rare, heterotopic pancreas can present with gastric outlet obstruction and cause diagnostic confusion with gastric cancer. Definitive diagnosis is by histology that can also guide limited resection intraoperatively.
Collapse
Affiliation(s)
- Gosa Bejiga
- Adama Hospital Medical College, Adama, P.O. Box:84, Ethiopia.
| |
Collapse
|
16
|
Nambu N, Yamasaki T, Nakagomi N, Kumamoto T, Nakamura T, Tamura A, Tomita T, Miwa H, Shinohara H, Hirota S. A case of ectopic pancreas of the stomach accompanied by intraductal papillary mucinous neoplasm with GNAS mutation. World J Surg Oncol 2021; 19:309. [PMID: 34674710 PMCID: PMC8529847 DOI: 10.1186/s12957-021-02424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ectopic pancreas is basically a benign disease and is not always necessary to be removed. However, all types of neoplasms occurring in the normal pancreas such as ductal adenocarcinomas and intraductal papillary mucinous neoplasms (IPMNs) may develop even within ectopic pancreas. We recently encountered an extremely rare case of ectopic pancreas in the gastric antrum associated with IPMN possessing a GNAS mutation. CASE PRESENTATION A 71-year-old Japanese woman complained of epigastric pain. Computed tomography and upper gastrointestinal endoscopy showed an intramural cystic mass in the antrum of the stomach. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy did not give a definitive diagnosis, and the patient underwent resection of the lesion. Histology of the resected specimen showed that the gastric intramural lesion was ectopic pancreas. Moreover, the lesion contained dilated duct components with tubulo-villous epithelial proliferation consistent with pancreatic IPMN. Since the covering epithelial cells had highly atypical nuclei, the lesion was diagnosed as IPMN with high grade dysplasia. Immunohistochemistry showed that the IPMN component showed to be MUC2-, MUC5AC-, and CDX2-positive but MUC1- and MUC6-negative. Mutational analyses using genomic DNA revealed that the IPMN component had a mutation of GNAS at exon 8 (Arg201Cys). CONCLUSION We finally diagnosed this case as gastric ectopic pancreas accompanied by intestinal type IPMN with high grade dysplasia possessing GNAS mutation. Although there were 17 cases of ectopic pancreas with IPMN including 6 cases of gastric ones reported in the English literature, this is the first case of ectopic pancreas with IPMN which was proved to have GNAS mutation. Intimate preoperative examinations including imaging analyses and EUS-FNA biopsy/cytology are recommended to decide whether the lesion has to be resected or not even if they are not effective for getting the right diagnosis.
Collapse
Affiliation(s)
- Naoko Nambu
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Takashi Yamasaki
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Nami Nakagomi
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tsutomu Kumamoto
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tatsuro Nakamura
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akio Tamura
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hiroto Miwa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Upper Gastrointestinal Division, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo, 663-8501, Japan.
| |
Collapse
|
17
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
18
|
Vyawahare MA, Musthyla NB. Ectopic pancreas at the ampulla of Vater diagnosed with endoscopic snare papillectomy: A case report and review of literature. World J Gastrointest Endosc 2021; 13:437-446. [PMID: 34630893 PMCID: PMC8474693 DOI: 10.4253/wjge.v13.i9.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic pancreas is a rare developmental anomaly that results in a variety of clinical presentations. Patients with ectopic pancreas are mostly asymptomatic, and if symptomatic, symptoms are usually nonspecific and determined by the location of the lesion and the various complications arising from it. Ectopic pancreas at the ampulla of Vater (EPAV) is rare and typically diagnosed after highly morbid surgical procedures such as pancreaticoduodenectomy or ampullectomy. To our knowledge, we report the first case of confirmed EPAV with a minimally invasive intervention.
CASE SUMMARY A 71-year-old male with coronary artery disease, presented to us with new-onset dyspepsia with imaging studies revealing a ‘double duct sign’ secondary to a small subepithelial ampullary lesion. His hematological and biochemical investigations were normal. His age, comorbidity, poor diagnostic accuracy of endoscopy, biopsies and imaging techniques for subepithelial ampullary lesions, and suspicion of malignancy made us acquire histological diagnosis before morbid surgical intervention. We performed balloon-catheter-assisted endoscopic snare papillectomy which aided us to achieve en bloc resection of the ampulla for histopathological diagnosis and staging. The patient’s post-procedure recovery was uneventful. The en bloc resected specimen revealed ectopic pancreatic tissue in the ampullary region. Thus, the benign histopathology avoided morbid surgical intervention in our patient. At 15 mo follow-up, the patient is asymptomatic.
CONCLUSION EPAV is rare and remains challenging to diagnose. This rare entity should be included in the differential diagnosis of subepithelial ampullary lesions. Endoscopic en bloc resection of the papilla may play a vital role as a diagnostic and therapeutic option for preoperative histological diagnosis and staging to avoid morbid surgical procedures.
Collapse
Affiliation(s)
- Manoj A Vyawahare
- Department of Medical Gastroenterology, American Oncology Institute at Nangia Specialty Hospital, Nagpur 440028, Maharashtra, India
| | - Naga Bharati Musthyla
- Department of Pathology, AmPath Central Reference Laboratory, Hyderabad 500019, Telangana, India
| |
Collapse
|
19
|
Bahadur A, Thakur V, Bains L, Arora P, Rathi Y, Shukla A. Giant Calculus with More than 100 Small Calculi in Choledochal Cysts. Case Rep Gastroenterol 2021; 15:244-252. [PMID: 33790711 PMCID: PMC7989771 DOI: 10.1159/000513145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 11/27/2022] Open
Abstract
Giant biliary calculus in the common bile duct (CBD) is rare. Giant calculus of choledochal cyst (CC) is even rarer, and no case of giant calculus of CC with more than 100 calculi has been reported in the indexed literature. We present the case of a 8.0 × 4.5 × 4.0 cm sized giant calculus with >100 small calculi in type IVa CCs with heterotopic pancreas in a 45-year-old male, which is a surprisingly rare occurrence. Magnetic resonance cholangiopancreatography showed multifocal irregular dilatation of intrahepatic biliary radicles with multiple filling defects with a giant calculus in CC with cholelithiasis. The case was successfully managed with open cholecystectomy and choledochotomy with retrieval of 1 giant and more than 100 small calculi with excision of CC with Roux-en-Y hepaticojejunostomy. Histopathological examination (HPE) showed inflamed CC identified with focal areas of surface ulceration with increased fibrosis areas in the wall and few pancreatic acini. A bile duct calculus is defined as “giant” when the size is 5 cm or more. Stone formation within is the most frequent complication of CC. Most intracystic calculi have been described as soft, earthy, and pigmented in appearance, supporting bile stasis as a primary etiologic factor. The only treatment for giant calculus of CBD or CC is surgical. Endoscopic treatment is mostly unsuccessful and open surgery is the treatment of choice due to giant size, increased load of calculus, and presence of calculi in the left and right hepatic ducts.
Collapse
Affiliation(s)
- Akshay Bahadur
- Department of Surgery, Dr. Hedgewar Arogya Sansthan, Delhi, India
| | - Vijay Thakur
- Department of General Surgery, Lal Bahadur Shastri Hospital, Delhi, India
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Prerna Arora
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Yanshul Rathi
- Department of Surgery, Dr. Hedgewar Arogya Sansthan, Delhi, India
| | - Ashish Shukla
- Department of Surgery, Dr. Hedgewar Arogya Sansthan, Delhi, India
| |
Collapse
|
20
|
Kumar A, Baksi A, Yadavalli SD, Aggarwal S. Incidental Jejunal Lesion Necessitating Intraoperative Change of Plan During Bariatric Surgery: a Video Case Report. Obes Surg 2021; 31:2344-2345. [PMID: 33469860 DOI: 10.1007/s11695-020-05162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/15/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
Incidental gastric and small bowel lesions are commonly encountered during bariatric surgery. Resection of these lesions with negative margins in the same sitting is curative; however, this may necessitate intraoperative change of plan. We present a 44-year-old super obese lady in whom an exophytic jejunal mass was found at 80 cm from the ligament of Treitz, which necessitated a change of procedure from one anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB). The final pathology was ectopic pancreatic tissue. Running the small bowel during initial diagnostic laparoscopy should be a routine step before division of stomach, to avoid technical complexities when operative plan is changed in order to resect an incidentaloma. Bariatric surgeons should be well versed with all the standard bariatric procedures.
Collapse
Affiliation(s)
- Arun Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029, India
| | - Aditya Baksi
- Department of Surgical Disciplines, All India Institute of Medical Sciences, 110029, New Delhi, India
| | - Sai Divya Yadavalli
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029, India
| | - Sandeep Aggarwal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, Ansari Nagar (East), New Delhi, 110029, India.
| |
Collapse
|
21
|
Yang CW, Liu XJ, Wei Y, Wan S, Ye Z, Yao S, Zeng N, Cheng Y, Song B. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol (NY) 2021; 46:168-178. [PMID: 32613400 DOI: 10.1007/s00261-020-02631-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine whether morphologic features and semiquantitative parameters of computed tomography (CT) could be used to distinguish heterotopic pancreas from gastrointestinal stromal tumor (GIST) and leiomyoma. METHODS This retrospective study evaluated CT images of heterotopic pancreases (n = 28), GISTs (n = 57), and leiomyomas (n = 26) located in the upper gastrointestinal tract. Morphologic imaging features of lesions were analyzed, including location, contour, margin, attenuation, growth pattern, enhancement type, enhancement degree, enlarged vessels feeding or draining the mass, hyperenhancement of the overlying mucosa, low intralesional attenuation, calcification, and a duct-like structure. Semiquantitative parameters included long diameter (LD), short diameter (SD), LD/SD ratio, and lesion and aorta CT values during plain CT (Lp and Ap), arterial phase (La and Aa), and venous phase (Lv and Av). Diagnostic performance of these findings and parameters were evaluated by receiver operating characteristic (ROC) analysis. RESULTS Morphologic CT findings (including lesion contour, margin, attenuation, growth pattern, enhancement type, and enhancement degree) and semiquantitative parameters except for LD/SD were demonstrated to be significant for differentiating heterotopic pancreas from GIST and leiomyoma (all P < 0.01). Of these, location, low intralesional attenuation, duct-like structure and LD, SD, Lv, and Sv values showed good diagnostic performance with the areas under curve (AUC) higher than 0.70. The presence of a duct-like structure demonstrated the best diagnostic ability with AUC of 0.929 [95% confidence interval (CI) 0.864-0.969], sensitivity of 5.7% (95% CI 67.3-96.0), and specificity of 100% (95% CI 95.7-100), respectively. When the three morphologic features (location, low intralesional attenuation, duct-like structure) were used in combination, the AUC was improved to 0.980 (95% CI 0.952-1). CONCLUSION CT features, especially the morphologic features, could be used to differentiate heterotopic pancreas from GIST and leiomyoma in the upper gastrointestinal tract and, thus, provide a more accurate method for non-invasive preoperative diagnosis. Additionally, the presence of a duct-like structure demonstrated to be a reliable indicator for heterotopic pancreas among the morphologic and semiquantitative CT features.
Collapse
Affiliation(s)
- Cai-Wei Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Shan Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yue Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| |
Collapse
|
22
|
Gadelha Bezerra Silva B, Veras Oliveira A, Almeida de Sousa Jucá M, de Sousa Nóbrega AG, Lopes PM, Feitosa Gomes JW, Alencar Barros AÁ. Management of gastric ectopic pancreas identified in preoperative evaluation of bariatric surgery - A case report. Int J Surg Case Rep 2020; 77:353-356. [PMID: 33217652 PMCID: PMC7683285 DOI: 10.1016/j.ijscr.2020.10.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 11/24/2022] Open
Abstract
The diagnosis of rare gastric lesions has become more frequent after the increase in bariatric surgery. The preoperative evaluation for bariatric surgery showed two lesions suggestive of Gastric Ectopic Pancreas. The previous identification of these lesions provides better surgical planning. Intraoperative Upper Endoscopy was used to identify the location of these lesions. Simultaneous laparoscopic resection of the lesions associated with Sleeve Gastrectomy was performed.
Background The diagnosis of gastric lesions, such as the Ectopic Gastric Pancreas (GEP), has become more frequent after the increase in bariatric surgeries. The most frequently used surgical options are: Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB). The scientific papers about GEP in Bariatric Surgery consisted of intraoperative findings, approach the lesion with gastrectomy and the need to change the initial surgical strategy of the Sleeve for others techniques which allow extended gastric resections. Presentation of case This is a report on a 21-year-old female patient with class 3 obesity whose preoperative evaluation showed two lesions suggestive of GEP. Simultaneous surgical video-laparoscopic treatment of lesions associated with SG aided by intraoperative Upper Endoscopy (UE) was performed with no perioperative complications. Conclusion It is possible to associate the treatment of rare gastric lesions with traditional surgery techniques for obesity.
Collapse
Affiliation(s)
- Bruno Gadelha Bezerra Silva
- Surgery Department, Division of General Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| | - Adriano Veras Oliveira
- Surgery Department, Division of Bariatric and Metabolic Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| | - Marcio Almeida de Sousa Jucá
- Surgery Department, Division of Bariatric and Metabolic Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| | - Antônio Gláucio de Sousa Nóbrega
- Surgery Department, Division of Bariatric and Metabolic Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| | - Paulo Marcos Lopes
- Surgery Department, Division of Bariatric and Metabolic Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil
| | - José Walter Feitosa Gomes
- Surgery Department, Division of General Surgery, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| | - André Átila Alencar Barros
- Endoscopy Department, Division of Upper Gastrointestinal Endoscopy, Hospital José Martiniano de Alencar, 1526, Princesa Isabel Street, Centro District, Fortaleza, Ceará, Brazil.
| |
Collapse
|
23
|
Noh JH, Kim DH, Kim SW, Park YS, Na HK, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas. World J Clin Cases 2020. [PMID: 33195638 DOI: 10.1016/j.gie.2019.03.1288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Gastric heterotopic pancreas (GHP) is generally asymptomatic and rarely features complications such as pancreatitis, pseudocysts, gastric outlet obstruction, bleeding, obstructive jaundice, or intussusception. However, the treatment of complicated GHP is challenging and often requires surgical resection. AIM To investigate the clinical outcomes of endoscopic submucosal dissection (ESD) as alternative to surgical resection for complicated GHP. METHODS This is a single-center, retrospective study. Between January 2013 and December 2017, a total of 5 patients underwent ESD for complicated GHP at Asan Medical Center. Patients who were diagnosed with complicated GHP were treated conservatively as with general practice for acute pancreatitis. After conservative management for resolving the acute phase of pancreatitis, ESD was performed as definitive treatment for complicated GHP. ESD was performed using the conventional method under conscious sedation. The clinical features of patients and tumors, procedure-related characteristics, and long-term outcomes were investigated. RESULTS The age of the 5 patients ranged from 28-43 years. Two of the patients were males. All lesions were located in the greater curvature of the antrum. On endoscopic ultrasonography during the pain episode, all lesions were located across the muscularis mucosa, submucosa, and proper muscle layers. The median lesion size was 20 [interquartile range (IQR), 18-35] during the pain episode at the time of the diagnosis of complicated GHP, and 15 mm (IQR, 9-33) at the time of ESD after conservative treatment. The procedure time ranged from 15-120 min. There were no procedure-related adverse events such as perforation or bleeding. The length of hospital stay after the procedure ranged from 2-4 d. All patients were symptom free during the median follow-up period of 46.0 mo (IQR, 39-60). CONCLUSION ESD appears to be a feasible and effective treatment option for complicated GHP based on the favorable clinical outcomes.
Collapse
Affiliation(s)
- Jin Hee Noh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea.
| | - So-Woon Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Young Soo Park
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Hee Kyong Na
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Ho June Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| |
Collapse
|
24
|
Noh JH, Kim DH, Kim SW, Park YS, Na HK, Ahn JY, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY. Endoscopic submucosal dissection as alternative to surgery for complicated gastric heterotopic pancreas. World J Clin Cases 2020; 8:4708-4718. [PMID: 33195638 PMCID: PMC7642560 DOI: 10.12998/wjcc.v8.i20.4708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/08/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric heterotopic pancreas (GHP) is generally asymptomatic and rarely features complications such as pancreatitis, pseudocysts, gastric outlet obstruction, bleeding, obstructive jaundice, or intussusception. However, the treatment of complicated GHP is challenging and often requires surgical resection.
AIM To investigate the clinical outcomes of endoscopic submucosal dissection (ESD) as alternative to surgical resection for complicated GHP.
METHODS This is a single-center, retrospective study. Between January 2013 and December 2017, a total of 5 patients underwent ESD for complicated GHP at Asan Medical Center. Patients who were diagnosed with complicated GHP were treated conservatively as with general practice for acute pancreatitis. After conservative management for resolving the acute phase of pancreatitis, ESD was performed as definitive treatment for complicated GHP. ESD was performed using the conventional method under conscious sedation. The clinical features of patients and tumors, procedure-related characteristics, and long-term outcomes were investigated.
RESULTS The age of the 5 patients ranged from 28-43 years. Two of the patients were males. All lesions were located in the greater curvature of the antrum. On endoscopic ultrasonography during the pain episode, all lesions were located across the muscularis mucosa, submucosa, and proper muscle layers. The median lesion size was 20 [interquartile range (IQR), 18-35] during the pain episode at the time of the diagnosis of complicated GHP, and 15 mm (IQR, 9-33) at the time of ESD after conservative treatment. The procedure time ranged from 15-120 min. There were no procedure-related adverse events such as perforation or bleeding. The length of hospital stay after the procedure ranged from 2-4 d. All patients were symptom free during the median follow-up period of 46.0 mo (IQR, 39-60).
CONCLUSION ESD appears to be a feasible and effective treatment option for complicated GHP based on the favorable clinical outcomes.
Collapse
Affiliation(s)
- Jin Hee Noh
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Do Hoon Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - So-Woon Kim
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Young Soo Park
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Hee Kyong Na
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Kee Wook Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Kee Don Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Ho June Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
| |
Collapse
|
25
|
Sciannamea A, Vaccari S, Marasco G, Dalla Via B, Lauro A, Marino IR, Vasuri F, Cervellera M, D'Andrea V, Tonini V. Concomitant Heterotopic Pancreas and Endometriosis as a Rare Cause of Ileo-Ileal Intussusception in a Young Woman with Spina Bifida: Case Report and Literature Review. Dig Dis Sci 2020; 65:2800-4. [PMID: 32572657 DOI: 10.1007/s10620-020-06410-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Isolated heterotopic pancreas (HP) as the primary cause of bowel intussusception is extremely rare. We report a case of a 33-year-old female patient with spina bifida admitted to the Emergency Surgical Department for ileal intussusception due to the presence of heterotopic pancreas associated with endometriosis. AREAS COVERED Symptomatic ileal intussusception for ectopic pancreas is usually associated with overt gastrointestinal blood loss (predominantly melena), abdominal pain, vomiting, and weight loss. Treatment is universally surgical. EXPERT COMMENTARY Isolated heterotopic pancreas is a rare condition; it should be considered in the differential diagnosis of bowel intussusception.
Collapse
|
26
|
Hisanaga E, Sano T, Kubo N, Ishii N, Shirabe K, Takagi H, Hirato J, Ikota H. Adenocarcinoma with intraductal papillary mucinous neoplasm arising in a duodenal heterotopic pancreas: a case report. Clin J Gastroenterol 2020; 13:1373-1382. [PMID: 32909157 DOI: 10.1007/s12328-020-01224-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023]
Abstract
A woman in her 70 s was diagnosed with a tumor in her duodenal wall during a routine visit for diabetes. She subsequently underwent subtotal stomach-preserving pancreatoduodenectomy. Histologically, the tumor was present mainly in the duodenal wall, and atypical cystic ducts were seen in the muscularis propria and subserosa. Invasive well-differentiated adenocarcinoma was seen in the duodenal submucosal and mucosal layers. Heterotopic pancreatic tissue was seen within the tumor, and atypical epithelium had proliferated and replaced the cystic ductal epithelium of the heterotopic pancreas. Therefore, adenocarcinoma with intraductal papillary mucinous neoplasm arising in duodenal heterotopic pancreas was the final histopathological diagnosis, which is considered rare.
Collapse
Affiliation(s)
- Etsuko Hisanaga
- Clinical Department of Pathology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Department of Internal Medicine, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan.
| | - Takaaki Sano
- Department of Diagnostic Pathology, Graduate School of Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norio Kubo
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Norihiro Ishii
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Clinical Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hitoshi Takagi
- Department of Internal Medicine, Kusunoki Hospital, 607-22 Fujioka, Fujioka, Gunma, 375-0024, Japan
| | - Junko Hirato
- Department of Pathology, Public Tomioka General Hospital, 2073-1 Tomioka, Tomioka, Gunma, 370-2393, Japan
| | - Hayato Ikota
- Clinical Department of Pathology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| |
Collapse
|
27
|
Ammar H, Said MA, Mizouni A, Farhat W, Harrabi F, Ghabry L, Gupta R, Ben Mabrouk M, Ben Ali A. Ectopic pancreas: A rare cause of occult gastrointestinal bleeding. Ann Med Surg (Lond) 2020; 59:41-43. [PMID: 32983446 PMCID: PMC7498733 DOI: 10.1016/j.amsu.2020.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Ectopic pancreas (EP) is a rare entity characterized by the development of pancreatic tissue in areas other than the pancreas. We present the case of a 16-year-old female with a heterotopic pancreas in the jejunum revealed by occult gastrointestinal bleeding. Contrast-enhanced computed tomography (CT) of the abdomen revealed a 2 × 3 cm enhancing nodular jejunal mass suspicious of a neuroendocrine or gastrointestinal stromal tumor. Octreoscan was planned but the patient presented in the emergency department with fever and sudden onset severe abdominal pain. The patient underwent emergency laparotomy. On abdominal exploration, appendicular perforation was present for which appendectomy and peritoneal lavage were performed. The small jejunal lesion seen on CT was identified during surgery and segmental jejunal resection with end-to-end anastomosis was performed. The histopathological examination of the jejunal mass revealed the presence of pancreatic acini and ductal structures without islets of Langerhans in the submucosa of the small intestine covered by normal mucosa. At the last follow-up of eight months after surgery, the patient is symptom-free and the abdominal CT is normal. Preoperative diagnosis of EP requires high clinical suspicion and should be included in the differential diagnosis while treating patients with gastrointestinal bleeding or gastrointestinal mass on CT. Ectopic pancreas (EP) is a rare entity characterized by the development of pancreatic tissue in areas other than the pancreas. It is often asymptomatic and mostly detected incidentally on surgery for other disease or on autopsy. The most common sites of EP are stomach and small intestine but it can be found in the esophagus, ileum, and biliary tree. EP should be included in the differential diagnosis while treating patients with gastrointestinal bleeding or gastrointestinal mass on CT.
Collapse
Affiliation(s)
- Houssem Ammar
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Amine Said
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Waad Farhat
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Fathia Harrabi
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Linda Ghabry
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | - Mohamed Ben Mabrouk
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Ali Ben Ali
- University of Sousse, Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| |
Collapse
|
28
|
Chiriatti E, Kuczma P, Galasso D, Koliakos E, Pezzetta E, Martinet O. Intramural ectopic pancreatic tissue of the stomach: A case report of an uncommon origin of a non-cancerous gastric tumour. Int J Surg Case Rep 2020; 73:48-51. [PMID: 32634617 PMCID: PMC7338994 DOI: 10.1016/j.ijscr.2020.06.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/16/2023] Open
Abstract
Ectopic pancreatic tissue is a rare incidental finding during abdominal surgery. 80% of the lesions are unifocal and less than 3 cm in size. The most frequent site is the stomach, followed by duodenum and proximal jejunum. The imaging modalities and endoscopic biopsy often remain inconclusive. Only resection and and histopathologic examination provide the definitve diagnosis.
Introduction Ectopic pancreatic tissue is often incidentally encountered during abdominal surgery. We report a case of an incidental finding during a laparoscopic appendectomy, the approach to diagnosis and management of this. The work has been reported in line with the SCARE criteria. Presentation of case A 32 year-old woman was diagnosed with an intramural pre-pyloric mass during a laparoscopic appendectomy. The lesion was identified on a subsequent computed tomography as a homogenous mass on the greater curvature. Upper esophagho-gastro-duodenoscopy was normal. The intramural mass was confirmed by an endoscopic sonography and the fine needle biopsy showed aspecific inflammatory cells. A laparoscopic wedge resection was realized. Histopathologic examination confirmed the diagnosis of an ectopic pancreatic tissue. Discussion The management of ectopic pancreas poses a medical challenge. The diagnostic quiver consists of radiologic exams and endoscopy, in combination with a direct biopsy of the lesion. Conclusion Despite the plethora of diagnostic modalities available, a definitive diagnosis for heterotopic pancreas often remains elusive, requiring more invasive diagnostic means. Although ample information is available in literature, there are currently no evidence-based guidelines regarding diagnosis and management of heterotopic pancreas.
Collapse
Affiliation(s)
- Enrica Chiriatti
- Department of General Surgery, Hospital Riviera - Chablais (HRC), Site of Montreux, Avenue de Belmont 25, 1820 Montreux, Switzerland.
| | - Paulina Kuczma
- Department of General Surgery, Hospital Riviera - Chablais (HRC), Site of Montreux, Avenue de Belmont 25, 1820 Montreux, Switzerland.
| | - Domenico Galasso
- Department of General Surgery, Hospital Riviera - Chablais (HRC), Site of Montreux, Avenue de Belmont 25, 1820 Montreux, Switzerland.
| | - E Koliakos
- Department of General Surgery, Hospital of Valais (CHVR), Avenue du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - Edgardo Pezzetta
- Department of General Surgery, Hospital Riviera - Chablais (HRC), Site of Montreux, Avenue de Belmont 25, 1820 Montreux, Switzerland.
| | - Olivier Martinet
- Department of General Surgery, Hospital Riviera - Chablais (HRC), Site of Montreux, Avenue de Belmont 25, 1820 Montreux, Switzerland.
| |
Collapse
|
29
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
30
|
Xiong Y, Xie Y, Jin DD, Wang XY. Heterotopic pancreas adenocarcinoma in the stomach: A case report and literature review. World J Clin Cases 2020; 8:1979-1987. [PMID: 32518790 PMCID: PMC7262711 DOI: 10.12998/wjcc.v8.i10.1979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/11/2020] [Accepted: 04/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heterotopic pancreas is a common lesion found in the gastrointestinal tract and is usually considered a benign disease. Reports of malignant change of heterotopic pancreas are scarce.
CASE SUMMARY A 44-year-old Chinese female underwent a gastroscopy to assess abdominal distension that had persisted for 2 months. A protruding lesion in the gastric antrum was revealed but no malignant tissue was found in the biopsy specimen. The patient's symptom persisted and progressed to repeated vomiting. Endoscopy after 4 months revealed obstruction of the gastric outlet caused by the protruding lesion. A distal gastrectomy was performed. Histopathological examination of the surgical specimen showed the malignant transformation of aberrant pancreas in the stomach. Chemotherapy consisting of folinic acid, fluorouracil, and oxaliplatin was administered for three cycles, and was changed to gemcitabine monotherapy because of adverse effects and increased serum tumor marker levels. The patient remained asymptomatic during a 12-month follow-up.
CONCLUSION Pancreatic heterotopy should be considered as source of a potentially malignant lesion, and early treatment or close monitoring for aberrant pancreas is recommended.
Collapse
Affiliation(s)
- Yao Xiong
- Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Yue Xie
- Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Dan-Dan Jin
- Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
| | - Xin-Ying Wang
- Department of Gastroenterology, Zhujiang Hospital of Southern Medical University, Guangzhou 510280, Guangdong Province, China
| |
Collapse
|
31
|
Abstract
Developmental anomalies of the pancreas include more common entities such as pancreas divisum and annular pancreas, and unusual entities such as heterotopic pancreas. While these anomalies can present a diagnostic challenge to the radiologist, when the pancreatic tissue involved in these processes develops pancreatitis, the radiographic appearance can present a diagnostic dilemma. Awareness of these pancreatic anomalies and familiarity with their appearance when inflamed is necessary to distinguish pancreatitis in the developmentally anomalous pancreas from other inflammatory or neoplastic processes.
Collapse
Affiliation(s)
- Cecil G Wood
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Camila Lopes Vendrami
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth Craig
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, 1120 15th Street BA-1411, Augusta, GA, 30912, USA
| | - Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St. Suite 800, Chicago, IL, 60611, USA.
| |
Collapse
|
32
|
Alqahtani A, Aljohani E, Almadi F, Billa S, Alqahtani M, Alkhaldi H. Heterotopic pancreatic tissue in the gastric antrum an incidental finding during bariatric surgery: A case report and literature review. Int J Surg Case Rep 2020; 67:39-41. [PMID: 32004902 PMCID: PMC7076269 DOI: 10.1016/j.ijscr.2019.12.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 11/29/2022] Open
Abstract
Heterotopic pancreas, is presence of pancreatic tissue outside its normal location without anatomic continuity with the main body of the pancreas. The Heterotopic pancreas can be in the stomach, duodenum, jejunum, or a Meckel diverticulum. This is the first reported case of gastric heterotopic pancreas found during a bariatric surgery procedure.
Introduction Heterotopic pancreas, also known as ectopic pancreas, is defined as the presence of pancreatic tissue outside its normal location and without anatomic and vascular continuity with the main body of the pancreas. The incidence of heterotopic pancreas has been reported as 0.5 % during laparotomies and at autopsy ranging from 0.6–14 %. Presentation of case A 28 years old obese male, medically free electively admitted for laparoscopic sleeve gastrectomy. Intraoperatively after dissecting the greater omentum from the stomach and inserting the 36 Fr gastric bougie, small oval shape mass about 1 cm close to the lesser curvature on the anterior surface of the gastric antrum. Macroscopically benign looking and a thorough laparoscopic exploration showed no signs of other organs involvement. Antrectomy and mini gastric bypass done. The postoperative course was uneventful. The histopathological examination of the antrectomy specimen showed heterotopic pancreas in the subserosa of gastric antrum. Discussion The Heterotopic pancreatic tissue can be discovered in the stomach (particularly antrum), duodenum, jejunum, or a Meckel diverticulum. Surgical resection is the mainstay treatment if the heterotopic pancreas is symptomatic or when the lesion is found incidentally during surgery in order to prevent complications. Conclusion Heterotopic pancreas should always be considered in the differential diagnosis of incidentally found gastric lesions and can be safely resected. This is the first case report of gastric heterotopic pancreas which is found incidentally during a bariatric surgery procedure.
Collapse
Affiliation(s)
| | - Emad Aljohani
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Fahad Almadi
- King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Srikar Billa
- Dr.Suliman Alhabib Hospital, Riyadh, Saudi Arabia
| | | | - Hisham Alkhaldi
- Histopathology Department, Dr.Suliman Alhabib Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
33
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
34
|
Affiliation(s)
- Priscilla Chamberlain
- Department of Pathology, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Anoop Prabhu
- Division of Gastroenterology, VA Ann Arbor Health System, Ann Arbor, MI, USA.,Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Filip Bednar
- Division of General Surgery, VA Ann Arbor Health System, Ann Arbor, MI, USA. .,Division of General Surgery, University of Michigan, Ann Arbor, MI, USA. .,2210 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
35
|
Rodrigo Lara H, Amengual Antich I, Quintero Duarte AM, De Juan Garcia C, Rodríguez Pino JC. Invasive ductal adenocarcinoma arising from heterotopic pancreas in the jejunum: Case report and literature review. Rev Esp Patol 2019; 52:194-198. [PMID: 31213261 DOI: 10.1016/j.patol.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/17/2018] [Accepted: 01/07/2019] [Indexed: 11/16/2022]
Abstract
Although the presence of pancreatic tissue outside of the usual anatomical location of the pancreas is not an uncommon incidental finding, the risk of malignancy is extremely low. We report a case of ductal adenocarcinoma arising within a focus of heterotopic pancreas, occurring in the jejunum of an 81 year old woman. The patient presented with a history of progressive gastrointestinal occlusive symptoms. Computerized tomography showed a mass in the jejunum, which was surgically removed. Histopathology revealed an invasive pancreatic ductal adenocarcinoma from pancreatic tissue with no connection with the original gland (Heinrich type II). At the 12-month follow-up, there were no signs of recurrence. Despite the low risk of malignancy in heterotopic pancreas, adenocarcinoma is the most frequent histological type, and the prognosis is still not clear. Lesions incidentally detected during surgery and in symptomatic patients need to be removed by conservative procedures in order to exclude malignant disease.
Collapse
Affiliation(s)
- Héctor Rodrigo Lara
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain.
| | - Isabel Amengual Antich
- Department of Pathology, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | | | - Carmen De Juan Garcia
- Department of Radiodiagnostic, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | | |
Collapse
|
36
|
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: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
37
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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].
Collapse
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.
| |
Collapse
|
38
|
Tang XB, Liao MY, Wang WL, Bai YZ. Mesenteric heterotopic pancreas in a pediatric patient: A case report and review of literature. World J Clin Cases 2018; 6:847-853. [PMID: 30510954 PMCID: PMC6264991 DOI: 10.12998/wjcc.v6.i14.847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/30/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Heterotopic pancreas (HP) is a congenital anomaly defined as pancreatic tissue that has no contact with the orthotopic pancreas and its own duct system and vascular supply. The most common locations of HP are the upper gastrointestinal tract, specifically, the stomach, duodenum, and proximal jejunum. Involvement of the mesentery is rare. Here, we describe a rare case of mesenteric heterotopic pancreas (MHP) in a 12-year-old girl who presented with acute abdomen. The patient underwent emergency laparotomy, and the mass and adjacent small bowel were resected. Results of the postoperative histopathologic examination confirmed the diagnosis of MHP. Observation of the patient for 12 mo postoperatively showed no evidence of recurrence. Preoperative diagnosis of HP is difficult, even in a symptomatic patient. Increased awareness and understanding of the image characteristics of MHP will aid in correct preoperative diagnosis and appropriate patient management.
Collapse
Affiliation(s)
- Xiao-Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Min-Yi Liao
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Wei-Lin Wang
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yu-Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, Liaoning Province, China
| |
Collapse
|
39
|
Toya T, Uehara K, Ito Y, Sasaki H, Matsuda H. Surgical Treatment of Jejunal Artery Aneurysm. EJVES Short Rep 2018; 40:15-17. [PMID: 30294683 PMCID: PMC6171461 DOI: 10.1016/j.ejvssr.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction A jejunal artery aneurysm (JAA) is rare and has few specific symptoms. Endovascular repair is widely used in the treatment of jejunal artery aneurysms; however, some patients still require open repair. Report A 59 year old man underwent open surgery with resection of the aneurysm and reconstruction using a saphenous vein graft. Histopathological examination revealed heterotopic pancreas around the aneurysm. Discussion Inflammation as a result of heterotopic pancreas was suspected as the cause of JAA. The advantage of open repair is to explore intestinal ischaemia directly. Furthermore, revascularisation with a saphenous vein graft may remove the possibility of post-operative intestinal ischaemia. A report of an atypical proximal jejunal artery aneurysm caused by inflammatory change resulting from heterotopic pancreas. Aneurym was resected and reconstructed with saphenous vein graft.
Collapse
Affiliation(s)
- Teppei Toya
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Kyokun Uehara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Yusuke Ito
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Centre, Suita, Japan
| |
Collapse
|
40
|
Li LM, Feng LY, Chen XH, Liang P, Li J, Gao JB. Gastric heterotopic pancreas and stromal tumors smaller than 3 cm in diameter: clinical and computed tomography findings. Cancer Imaging 2018; 18:26. [PMID: 30086800 PMCID: PMC6081935 DOI: 10.1186/s40644-018-0161-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/29/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Identifying gastric heterotopic pancreas and stromal tumors is difficult. Few studies have reported computed tomography (CT) findings for differentiating lesions less than 3 cm in diameter. In this study, we aimed to identify clinical characteristics and CT findings that can differentiate gastric heterotopic pancreatic lesions from stromal tumors less than 3 cm in diameter. METHODS A total of 132 patients with pathologically confirmed gastric heterotopic pancreas (n = 66) and stromal tumors (n = 66) were included. Each group was divided into primary (n = 50) and validation cohort (n = 16). Clinical characteristics and CT findings were retrospectively reviewed. CT findings included location, border, contour, growth pattern, enhancement pattern and grade, the enhancement value of tumor, enhancement ratio of tumor, and enhancement ratio of tumor to pancreas in venous phase. The findings in the two groups were compared using the Pearson χ2 test or Student t-test. Receiver operating characteristic curves were used to determine areas under the curve and optimal cut-offs. RESULTS Significant differences were observed between heterotopic pancreas and stromal tumors in the distribution of tumor location, border, contour (all P < 0.001), enhancement values (P < 0.001), enhancement ratios of tumors (P < 0.001), and enhancement ratios of tumors to pancreas (P < 0.001). No significant differences existed in growth pattern (P = 0.203). The area under the curve differed significantly between enhancement ratio of tumor to pancreas and enhancement ratio (P = 0.030). There were significant differences in above characteristics between two groups in validation cohort. CONCLUSIONS Heterotopic pancreas has characteristic CT features differentiating it from stromal tumors.
Collapse
Affiliation(s)
- Li-Ming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Lei-Yu Feng
- Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Xiao-Hua Chen
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jing Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
| |
Collapse
|
41
|
Juricic M, Djagbare DY, Carmassi M, Panait N, Faure A, NDour O, NGom G, Merrot T. Heterotopic pancreas without Meckel's diverticulum in children as unique cause of gastrointestinal bleeding: think about it! Surg Radiol Anat 2018; 40:963-965. [PMID: 29785678 DOI: 10.1007/s00276-018-2042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/16/2018] [Indexed: 12/27/2022]
Abstract
Ectopic pancreas also known as heterotopic pancreas (HP) is a rare congenital anomaly, mainly found as incidental finding during autopsy or abdominal exploration for an other condition. Incidence rate is probably underestimated as patients are mostly asymptomatic; otherwise, it is capable of producing symptoms depending on its location, size, often appearing in the 4th-to-6th decades. Complications such as inflammation, obstruction, bleeding, and malignancy degeneration must be considered. Pediatrics cases are very rare, generally concerning HP within Meckel's diverticulum, manifesting by gastrointestinal bleeding and intussusception. We report a rare case of jejunum bleeding, due to an isolated HP in a 15-year-old adolescent. Endoscopic and computed tomographic scan were normal, in particular did not found Meckel's diverticulum. Diagnosis and treatment have been apprehended performing a laparoscopic exploration. It is a singular location for HP, predominantly found in upper gastrointestinal tractus. So far, there have been no case reports of jejunal bleeding from ectopic pancreas without Meckel's diverticulum in children.
Collapse
Affiliation(s)
- Mélodie Juricic
- Service de Chirurgie Infantile, Hopital des Enfants, CHU Toulouse, Toulouse, France.
| | | | - Marion Carmassi
- Service d'anatomopathologie, Hôpital Nord, 13015, Marseille Cedex 20, France
| | - Nicoleta Panait
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
| | - Alice Faure
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
| | - Oumar NDour
- Service de Chirurgie Pédiatrique, Hôpital Aristide Le Dantec, Dakar, Senegal
| | - Gabriel NGom
- Service de Chirurgie Pédiatrique, Hôpital Aristide Le Dantec, Dakar, Senegal
| | - Thierry Merrot
- Service de Chirurgie Infantile, Hôpital de la Timone, 13005, Marseille Cedex 20, France
| |
Collapse
|
42
|
Henderson L, Nour S, Dagash H. Heterotopic Pancreas: A Rare Cause of Gastrointestinal Bleeding in Children. Dig Dis Sci 2018; 63:1363-5. [PMID: 29468375 DOI: 10.1007/s10620-018-4981-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/13/2018] [Indexed: 12/30/2022]
|
43
|
Abstract
There are few English reports on secondary tumors from heterotopic pancreas. Here, we describe a case of gastric neuroendocrine tumor (NET) arising from heterotopic pancreas. A 72-year-old woman underwent esophagogastroduodenoscopy as part of a general health check-up. An endoscopic examination revealed a submucosal tumor on the greater curvature of the gastric body. Laparoscopic and endoscopic cooperative surgery was performed. Histological diagnosis concluded that it was a Grade 1 NET arising from heterotopic pancreas. We report this extremely rare case of a NET presenting as a submucosal tumor, considered to have originated from heterotopic pancreatic tissue.
Collapse
Affiliation(s)
- Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, Japan.
| | - Rika Omote
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Okazaki
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
44
|
Abstract
There are few English reports on secondary tumors from heterotopic pancreas. Here, we describe a case of gastric neuroendocrine tumor (NET) arising from heterotopic pancreas. A 72-year-old woman underwent esophagogastroduodenoscopy as part of a general health check-up. An endoscopic examination revealed a submucosal tumor on the greater curvature of the gastric body. Laparoscopic and endoscopic cooperative surgery was performed. Histological diagnosis concluded that it was a Grade 1 NET arising from heterotopic pancreas. We report this extremely rare case of a NET presenting as a submucosal tumor, considered to have originated from heterotopic pancreatic tissue.
Collapse
Affiliation(s)
- Takehiro Tanaka
- Department of Pathology, Okayama University Hospital, Okayama, Japan.
| | - Rika Omote
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriko Okazaki
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
45
|
Darlington CD, Anitha GFS. Meckel's Diverticulitis Masquerading as Acute Pancreatitis: A Diagnostic Dilemma. Indian J Crit Care Med 2017; 21:789-792. [PMID: 29279643 PMCID: PMC5699010 DOI: 10.4103/ijccm.ijccm_317_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Meckel's diverticulum is a remnant of the proximal part of the vitellointestinal duct and is the most common congenital anomaly of the gastrointestinal tract. It may either remain asymptomatic or present with myriad of clinical presentations. Gastrointestinal bleeding is the most common presentation in children whereas it is intestinal obstruction in the case of adults. We report a 9-year-old boy who presented with acute onset of periumbilical pain and nonbilious vomiting. His clinical and laboratory parameters were unremarkable, except for serum amylase levels. He was conservatively managed initially as acute pancreatitis with paralytic ileus. However, the child deteriorated in a course of 2 days with bilious vomiting, abdominal distension, and dehydration. Imaging was suggestive of an ileoileal intussusception, and exploratory laparotomy identified Meckel's diverticulum as the lead point for the intussusception. The histopathological examination revealed inflamed heterotopic pancreatic tissue at the apex of the diverticulum thus explaining the elevated amylase levels. This case is reported to highlight the atypical presentation of Meckel's diverticulum and the high clinical suspicion warranted in diagnosing such concomitant intussusception.
Collapse
|
46
|
Jin HB, Lu L, Yang JF, Lou QF, Yang J, Shen HZ, Tang XW, Zhang XF. Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas. World J Gastroenterol 2017; 23:6365-6370. [PMID: 28974904 PMCID: PMC5603504 DOI: 10.3748/wjg.v23.i34.6365] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/10/2017] [Accepted: 08/02/2017] [Indexed: 02/07/2023] Open
Abstract
Heterotopic pancreas (HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography (EUS)-guided fine needle aspiration (EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.
Collapse
Affiliation(s)
- Hang-Bin Jin
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Lei Lu
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Feng Yang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Qi-Feng Lou
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Jing Yang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Hong-Zhang Shen
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Wei Tang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Hangzhou First People’s Hospital, Nanjing Medical University, Hangzhou 310000, Zhejiang Province, China
| |
Collapse
|
47
|
Yoon JB, Lee BE, Kim DH, Park DY, Jeon HK, Baek DH, Kim GH, Song GA. A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas. Clin Endosc 2017; 51:192-195. [PMID: 28854774 PMCID: PMC5903075 DOI: 10.5946/ce.2017.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/27/2022] Open
Abstract
Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.
Collapse
Affiliation(s)
- Jung Bin Yoon
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dae Hwan Kim
- Department of Surgery, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Do Youn Park
- Department of Pathology, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hye Kyung Jeon
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
48
|
Zhao Z, Sim CK, Mantoo S. Heterotopic pancreas in the omphalomesenteric duct remnant in a 9-month-old girl: a case report and literature review. Diagn Pathol 2017; 12:49. [PMID: 28679401 PMCID: PMC5498890 DOI: 10.1186/s13000-017-0643-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 06/30/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Heterotopic pancreas most commonly occurs in the upper gastrointestinal tract of adults, usually as an incidental finding. It seldom occurs at the umbilicus, and even rarely in the pediatric age group. CASE PRESENTATION Here we present a case of heterotopic pancreatic tissue in the omphalomesenteric duct remnant of a 9-month-old baby girl. She presented with redness at the base of the umbilicus associated with occasional mild wetness. A urachal fistula was suspected by ultrasound. Histology from subsequent resection revealed fibrous tissue with heterotopic pancreatic tissue and accompanying small bowel mucosa. The patient's umbilical redness resolved after the surgery. CONCLUSIONS Upon literature search, we found only 17 other cases of heterotopic pancreas reported in the umbilicus. They described a high male to female ratio, frequent association with omphalomesenteric duct remnant and presentation of umbilical discharge. The Heinrich system is frequently used to classify heterotopic pancreas into 3 types, based on the presence of acini, islets and ducts. Several mechanisms have been proposed on the pathogenesis of heterotopic pancreas, including misplacement, metaplasia and totipotent cell theories. Heterotopic pancreas can manifest clinically with diseases of the pancreas, including malignant transformation, reported as high as 12.7% in a series. Awareness of this finding in the biopsy aids the suitable treatment decisions for the patient.
Collapse
Affiliation(s)
- Zitong Zhao
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore, Singapore
| | - Chiang Khi Sim
- Pediatric Surgery, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Sangeeta Mantoo
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore, Singapore.
| |
Collapse
|
49
|
Lin YM, Chiu NC, Li AFY, Liu CA, Chou YH, Chiou YY. Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review. World J Gastroenterol 2017; 23:2493-2504. [PMID: 28465633 PMCID: PMC5394512 DOI: 10.3748/wjg.v23.i14.2493] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 01/25/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Although gastric tumors have overlapping radiologic appearances, some unusual tumors may present specific imaging features. Using multidetector computed tomography (MDCT), with water as a negative oral contrast agent and intravenous contrast medium, can provide critical information for the diagnosis of gastric diseases. In addition, MDCT can evaluate the involvement of the gastric wall and extragastric extent of the disease, as compared with gastroenteroscopy and double-contrast upper gastrointestinal study. Regarding lesion location and size, enhancing and growth patterns, presence of calcification or fat, and involvement of the gastric wall and adjacent structures, CT may provide useful information. In this review article, we review the relevant literature and discuss the CT features and the histopathologic findings of different types of gastric lesions. The lesions are divided into benign (glomus tumors, schwannomas, leiomyomas, and lipomas), malignant (gastrointestinal stromal tumors, mucinous carcinomas, lymphomas, and carcinoid tumors), and tumor-like lesions (ectopic pancreas and bezoar). Familiarity with imaging appearances and pathologic findings can help physicians make an accurate diagnosis.
Collapse
|
50
|
Kim KM, Kim CY, Hong SM, Jang KY. A primary pure pancreatic-type acinar cell carcinoma of the stomach: a case report. Diagn Pathol 2017; 12:10. [PMID: 28103943 DOI: 10.1186/s13000-017-0601-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/13/2017] [Indexed: 12/17/2022] Open
Abstract
Background Acinar cell carcinoma represents only 1–2% of exocrine pancreatic neoplasms. On exceptionally rare occasions, primary acinar cell carcinoma can occur in ectopic locations. Herein, we report a case of pure pancreatic-type acinar cell carcinoma arising in the stomach. Case presentation A 54-year-old male presented with a gastric submucosal mass detected by endoscopic examination. Laparoscopic wedge resection was performed. Macroscopically, the 2.7 cm yellowish mass was located in the submucosa of the stomach. Microscopically, the tumor was well circumscribed and had a homogeneous acinar architecture. The tumor cells were small and had a minimal amount of cytoplasm. The nuclei of the tumor cells were round to oval with finely dispersed chromatin. The tumor cells were strongly positive for α1-antitrypsin, chymotrypsin, and α1-antichymotrypsin immunostaining, consistent with pancreatic exocrine differentiation. There was no clinical or radiologic evidence of primary pancreatic or head and neck tumors. After surgical resection of the tumor, there was no recurrence or metastasis during 33 months follow-up. Conclusion In this report, we have presented a rare case of primary pure pancreatic-type acinar cell carcinoma arising in the stomach and suggest that it could be helpful if the pathologist were aware that pancreatic-type acinar cell carcinoma could arise in the stomach as a polypoid submucosal tumor in the routine diagnostic field of gastric endoscopy.
Collapse
|