Heterotopic pancreatic tissue in the gallbladder: A rare incidental finding (original) (raw)
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Heterotopic Pancreas in the Gallbladder: Case Report and Literature Review
Case Reports in Medicine, 2021
Introduction. Heterotopic pancreas (HP) is the congenital presence of pancreatic tissue outside its normal location in the absence of vascular and anatomical connection with the main pancreas. HP can affect any part of the gastrointestinal tract, and it is mostly encountered in the stomach. The gallbladder is a rare site of HP, and our literature review revealed that only 38 cases were reported. We present a case of HP in the gallbladder that was presented with a picture of acute cholecystitis. After the case presentation, we will discuss HP in the gallbladder by reviewing the literature. Case Presentation. A 49-year-old male presented to the emergency department complaining of progressively worsening right upper abdominal pain for the last 24 hours. After thorough history and physical examination, a provisional diagnosis of acute cholecystitis was made. Abdominal ultrasonography revealed a rim of edema surrounding the gallbladder wall with two stones impacted at the gallbladder nec...
Successful preoperative diagnosis of Heterotopic Pancreas in the Duodenum
International Journal of Surgery Case Reports, 2019
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 extraabdominal 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].
Heterotopic pancreas in the stomach: A case report and literature review
World Journal of Gastroenterology, 2007
clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation [2]. We report a case of a 40-year-old female with an ectopic pancreatic lesion in the antrum of the stomach. CASE REPORT A 40-year-old woman was admitted to our hospital due to a 2-mo history of recurrent episodes of epigastric pain, nausea and vomiting. Physical examination, routine blood tests including amylase, plain chest and abdominal X rays along with abdominal ultrasound were unremarkable. Esophagogastroduodenoscopy revealed a sessile polypoid mass with benign features located in the gastric antrum to the posterior wall measuring approximately 2 cm in diameter. The mucosa appeared normal throughout the stomach. Biopsy confirmed the presence of a normal gastric mucosa over the lesion. Computed tomography was not performed. A decision was made to proceed with surgery. Endoscopic injection with methylene blue was performed to mark the lesion preoperatively. The patient underwent explorator y laparotomy. Through a small midline incision a gastrotomy was performed. The lesion was clearly stained with methylene blue 4 h after the endoscopy. It was located approximately 10 cm from the pylorus to the greater curvature. In palpation the lesion was rubber like, fixed to the surrounding mucosa giving the feeling 'like a breast fibroadenoma'. Its dimension was approximately 5 cm × 3 cm × 4 cm. By using a stapler device a wedge resection of the lesion was performed with macroscopically clear margins. Frozen sections excluded malignancy and the possibility of ectopic pancreatic lesion. The surgical margins were clear. The patient had no postoperative complications and was discharged 4 d later. She has remained free of symptoms with negative endoscopy since then. Histopathologic examination of the lesion showed heterotopic pancreatic tissue in the gastric antrum with a lobular architecture characteristic of ectopic pancreas. The pancreatic lobules were located mainly in the gastric submucosa (Figure 1A) and partially in the muscularis propia (Figure 1B). They contained a mixture of pancreatic acini, ducts and islets of Langerhans. The overlying gastric mucosa was normal. DISCUSSION Ectopic pancreas is defined as pancreatic tissue that lacks anatomical or vascular communication with the normal
Duodenal heterotopic pancreatic tissue: a case report and literature review
Gastroenterology Report, 2014
Heterotopic pancreas is an aberration in the developmental profile of the pancreas. This entity is rarely symptomatic and its malignant transformation is even rarer. However, when present, it poses a diagnostic dilemma to clinicians, as little help comes from gastroenteroscopy and imaging. Surgical exploration remains the only option at times, and it is the histopathological examination that finally clears the mist. This case report reveals the elusive nature of malignancy in heterotopic pancreas in the duodenum.
Case report Duodenal heterotopic pancreatic tissue: a case report and literature review
2014
Heterotopic pancreas is an aberration in the developmental profile of the pancreas. This entity is rarely symptomatic and its malignant transformation is even rarer. However, when present, it poses a diagnostic dilemma to clinicians, as little help comes from gastroenteroscopy and imaging. Surgical exploration remains the only option at times, and it is the histopathological examination that finally clears the mist. This case report reveals the elusive nature of malignancy in heterotopic pancreas in the duodenum.
Journal of the Pancreas, 2015
Context Pancreatic heterotopia, the presence of pancreatic tissue anywhere outside of the anatomical pancreas, is rare and typically an incidental finding. This manuscript reports two index cases of unusual presentations of pancreatic heterotopia masquerading as malignant lesions. Case reports Case #1: Fifty-five year-old female with right upper quadrant pain was found to have a retroperitoneal tumor between the right kidney and liver. Case #2: Thirty-eight-year-old female with a 20-year history of right upper quadrant pain and pancreatitis was found to have an incidental jejunal mass. An intraoperative frozen section was ordered on these two patients for suspected malignancy. Frozen section analysis in both cases showed the presence of benign glandular tissue admixed with ducts in a typical lobular fashion consistent with benign pancreatic tissue, confirming pancreatic heterotopia. The two index cases were investigated and analyzed in detail with relevant review of the literature as available in PubMed and Medline. A fifteen-year retrospective computer-based histopathological surgical review was conducted in our laboratory and the results were analyzed in the context of evidence-based literature of pancreatic heterotopias. 153 pancreatic pathologies were identified of which the commonest lesion was adenocarcinoma (58.8%) followed by pancreatic heterotopia (10.5%), pancreatic neuroendocrine tumors (7.2%) and pancreatitis (7.2%). Conclusions Pancreatic heterotopia is rare and most often an incidental finding; however, occasionally patients may present with a mass suggestive of malignancy, leading to clinical diagnostic dilemmas. Awareness of this uncommon lesion is of particular importance at intraoperative frozen section analysis for lesions in atypical locations.
A Rare Pathology Mimicking the Gallstone: Heterotopic Pancreas in the Gallbladder
The placement of pancreatic tissue in an organ outside the pancreas is called pancreatic heterotopy. Heterotopic pancreatic (HP) tissue is frequently observed in the stomach and duodenum, while the gallbladder is an extremely rare localization. In this article, we present pancreatic heterotopy located in the gallbladder, a rarely observed embryologic anomaly, with the study of two cases and a review of the literature.
Pancreatic heterotopia in the gall bladder: a case report and literature review
Pancreatic heterotopia in the gall bladder is a rare entity, with approximately 31 cases reported in English language literature until 2006; there are no Brazilian studies on the topic. As it is usually asymptomatic, the definitive diagnosis is made by the anatomopathological material excised due to common diseases of the organ, such as lithiasis, inflammatory processes, polyps and tumors. A case is reported of a 40-year-old female patient submitted to surgery with a diagnosis of lithiasic cholecystopathy. Ectopy was evidenced by the histological study, due to the presence of acinar and ductal components of the pancreas and gall bladder corpus. The authors used their own pathological classification for this ectopy, and recommended that this entity be included more frequently in the differential diagnosis of alithiasic cholecystopathy and intramural and exophytic lesions of the gall bladder.
Pancreatic Heterotopia of the Duodenum: Anatomic Anomaly or Clinical Challenge?
Journal of Gastrointestinal Surgery, 2011
Introduction Pancreatic heterotopia (PH) is a common congenital anomaly and can occur anywhere in the gastrointestinal tract (GIT). In most cases, these heterotopias are asymptomatic and are only incidentally detected upon pathohistological examination or autopsy. We analyzed our cases of duodenal PH with respect to their clinical relevance and impact. Materials and Methods Our prospectively collected pancreatic database was retrospectively analyzed. Thirty-four cases of duodenal PH were found. Specimens were reviewed by a GI pathologist. Classification was performed according to Heinrich (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts). Results From January 2000 to June 2009, we performed 534 pancreatic head resections. Thirty-two patients (6.0%) were found to have duodenal PH. Indications for pancreatic resections (pylorus-preserving pancreaticoduodenectomy, n=26; Whipple, n=6) were as follows: chronic pancreatitis, n=16; malignancies, n=9; cystic neoplasms, n=5; and neuroendocrine neoplasms, n=2. PH was also detected after two partial duodenal resections. In total, two cases of duodenal PH were found to be symptomatic. According to Heinrich, the following types were found: Type I, n=12; Type II, n=17; and Type III, n=5 (total n=34). Conclusions PH is rare and in most cases detected incidentally during pathohistological examination. However, in two of our patients, surgery was performed due to symptoms. Therefore, in patients with unclear pancreatoduodenal lesions, PH should be considered as a possible diagnosis. Resection is indicated for symptomatic cases.