Successful preoperative diagnosis of Heterotopic Pancreas in the Duodenum (original) (raw)
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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
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.
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.
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.
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.
An unusual case of gastric heterotopic pancreas
JOP: Journal of the pancreas
Context Submucosal lesions of the gastrointestinal tract represent a diagnostic challenge for the physician. Endoscopic ultrasonography may provide useful information before deciding on therapeutic strategy.
Obstructing gastric heterotopic pancreas: case report and literature review
Clinical Imaging
Heterotopic pancreas (HP) is generally an asymptomatic lesion and is a rare cause of gastric outlet obstruction. We report such a case in which both upper gastrointestinal series and abdominal computerized tomography (CT) demonstrated an antral mass; surgical and histological results are also reported. D 0899-7071/02/$ -see front matter D 2002 Elsevier Science Inc. All rights reserved. PII: S 0 8 9 9 -7 0 7 1 ( 0 1 ) 0 0 4 0 8 -9
Pancreatology, 2004
Background: Heterotopic pancreas appears in 0.5 to 13% of autopsies. The most frequent locations are stomach, duodenum or upper jejunum. Pancreatitis in heterotopic pancreas is rarely described, and clinical symptoms caused by this heterotopic inflammation are uncommon. Method: We report a case of heterotopic pancreatitis localized in the major duodenal papilla causing biliary obstruction and mimicking a pancreatic head tumor. Clinically and radiologically, malignancy was suspected. Preoperative biopsies showed only fibrosis. A pylorus preserving resection of the pancreatic head was performed followed by an uneventful postoperative course. Result: Macroscopically, in the periampullary region on the pancreatic side a thickened duodenal wall with multiple lobules and cysts was found, compressing the common bile duct. Microscopic examination showed heterotopic pancreas with inflammatory lesions surrounding the ampulla. In the orthotopic pancreas a diffuse chronic pancreatitis with marked inflammation, fibrosis and atrophy of exocrine tissue was found. Conclusion: In our case it was impossible to differentiate between chronic pancreatitis and pancreas carcinoma preoperatively. Radiological findings and endoscopic biopsies were not sufficient to distinguish heterotopic pancreatitis from other tumors of the pancreatic head. Clear diagnosis could only be made by complete histological examinations after pancreatic head resection, being the treatment of choice for pancreatic head tumors of unclear dignity. The differential diagnosis of heterotopic pancreatitis as trigger of unclear enlargement of the pancreatic head is very seldom.