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Şerboiu CS, Aliuș C, Dumitru A, Țăpoi D, Costache M, Nica AE, Alexandra-Ana M, Antoniac I, Grădinaru S. Gallbladder Pancreatic Heterotopia-The Importance of Diagnostic Imaging in Managing Intraoperative Findings. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1407. [PMID: 37629697 PMCID: PMC10456474 DOI: 10.3390/medicina59081407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Pancreatic heterotopy is a rare entity defined as the presence of abnormally located pancreatic tissue without any anatomical or vascular connection to the normal pancreas. Heterotopic pancreatic tissue can be found in various regions of the digestive system, such as the stomach, duodenum, and upper jejunum, with the less commonly reported location being the gallbladder. Gallbladder pancreatic heterotopia can be either an incidental finding or diagnosed in association with cholecystitis. Pancreatitis of the ectopic tissue has also been described. In this context, we report three cases of heterotopic pancreatic tissue in the gallbladder with different types of pancreatic tissue according to the Heinrich classification. One patient was a 24-year-old male who presented with acute pancreatitis symptoms and an ultrasonographical detected mass in the gallbladder, which proved to be heterotopic pancreatic tissue. The other two cases were female patients aged 24 and 32, respectively, incidentally diagnosed on histopathological examination after cholecystectomy for symptomatic cholelithiasis. Both cases displayed chronic cholecystitis lesions; one of them was also associated with low grade dysplasia of the gallbladder. Although a rare occurrence in general, pancreatic heterotopia should be acknowledged as a possible incidental finding in asymptomatic patients as well as a cause for acute cholecystitis or pancreatitis.
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Affiliation(s)
- Crenguţa Sorina Şerboiu
- Department of Cellular, Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Cătălin Aliuș
- Surgical Department IV, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Adrian Dumitru
- Pathology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Dana Țăpoi
- Pathology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Mariana Costache
- Pathology Department, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Adriana Elena Nica
- Intensive Care Unit, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | | | - Iulian Antoniac
- Department of Metallic Materials Sciense and Physical Metallurgy, Faculty of Materials Science and Engineering, University Politehnica of Bucharest, 060042 Bucharest, Romania
| | - Sebastian Grădinaru
- Department of General Surgery, County Hospital Ilfov, 050474 Bucharest, Romania
- Titu Maiorescu University of Medicine and Pharmacy, 031593 Bucharest, Romania
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S L, A D, A C, F C, C T, D B, M C, G T C. Heterotopic Pancreatic Tissue in the Gallbladder: a Report of a Very Rare Case. J Gastrointest Cancer 2021; 52:1175-1179. [PMID: 34263429 DOI: 10.1007/s12029-021-00663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Lauricella S
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy.
| | - Dell'Ovo A
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy
| | - Coppola A
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy
| | - Carannante F
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy
| | - Taffon C
- Unit of Pathology, Medico University of Rome, Campus Bio, Rome, Italy
| | - Borzomati D
- Department of Digestive Surgery, Medico of Rome University, Campus Bio, Rome, Italy
| | - Caricato M
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy
| | - Capolupo G T
- Department of General Surgery, Division of Colon and Rectal Surgery, Medico of Rome University, Campus Bio, 00128, Rome, Italy
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Heterotopic Pancreas in the Gallbladder: Case Report and Literature Review. Case Rep Med 2021; 2021:6611291. [PMID: 33564313 PMCID: PMC7867455 DOI: 10.1155/2021/6611291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/21/2021] [Indexed: 12/03/2022] Open
Abstract
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 neck. Laparoscopic cholecystectomy was performed with an uneventful postoperative course, and the patient was discharged the next day. Microscopic examination of the gallbladder showed that a heterotopic pancreatic tissue, composed of a large number of pancreatic acini and few ducts with the absence of islets of Langerhans, was found around the cystic duct. The patient was asymptomatic at the regular follow-up six months postoperatively. Conclusion HP in the gallbladder is an extremely rare finding. Its clinical presentation is not different from other cholecystopathic diseases. Most cases were accompanied by cholelithiasis. Preoperative laboratory and imaging modalities are usually not helpful in the diagnosis of HP in the gallbladder. The definitive diagnosis is made by histological examination of the gallbladder specimen. Laparoscopic cholecystectomy is sufficing treatment.
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Kantor M, Eiseler S, Schiller A, Hughes S, Liu X, Lai J. Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review. Clin Res Hepatol Gastroenterol 2018; 42:e72-e76. [PMID: 29625925 DOI: 10.1016/j.clinre.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 02/04/2023]
Abstract
Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.
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Affiliation(s)
- M Kantor
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States.
| | - S Eiseler
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States
| | - A Schiller
- Department of Pathology, Kendall Regional Medical Center, Miami, FL, United States
| | - S Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - X Liu
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
| | - J Lai
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
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Gastric Heterotopic Pancreas: Computed Tomography With Clinicopathologic Correlation. J Comput Assist Tomogr 2017; 41:675-678. [PMID: 28448405 DOI: 10.1097/rct.0000000000000606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Asymptomatic heterotopic pancreas (HP) is benign and can be monitored long term without further intervention. Heterotopic pancreas is sometimes surgically resected because it can be difficult to distinguish HP from neoplastic submucosal masses such as gastrointestinal stromal tumors. Although it is not very common, HP should be considered in the differential diagnosis when diagnosing extramucosal gastric masses to avoid unnecessary intervention. We review gastric HP with pathologic correlation to help with diagnosing HP on computed tomography.
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Pancreatic heterotropia in wall of extra-hepatic choledochal cysts: A retrospective analysis of thirteen of such cases from north India. Pathol Res Pract 2017; 213:1109-1111. [DOI: 10.1016/j.prp.2017.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/28/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
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Basrur GB, Utture SK, Deshpande AA. Heterotopic Pancreas in the Gallbladder. Indian J Surg 2016; 78:429-430. [PMID: 27994347 DOI: 10.1007/s12262-016-1561-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gurudutt Bhaskar Basrur
- Grant medical college and Sir J.J. group of hospitals, Mumbai, India ; A-303, Shreeji Paradise, Ramesh Nagar, Amboli Andheri West, Mumbai, 400 058 India
| | - Shiv Kumar Utture
- Department of surgery, Grant medical college, Byculla, Mumbai, 400008 India
| | - Apurv A Deshpande
- Department of surgery, Grant medical college, Byculla, Mumbai, 400008 India
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Kaur N, Chander B, Kaur H, Kaul R. Cholecystitis Associated with Heterotopic Pancreas, Pseudopyloric Metaplasia, and Adenomyomatous Hyperplasia: A Rare Combination. J Lab Physicians 2016; 8:126-8. [PMID: 27365925 PMCID: PMC4866385 DOI: 10.4103/0974-2727.180795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heterotopic pancreatic tissue in the gall bladder is an uncommon incidental finding in most cases. We hereby describe the case of a 45-year-old woman who presented with symptoms of acalculous cholecystitis. Pathological examination detected heterotopic pancreatic tissue, pseudopyloric metaplasia, and adenomyomatous hyperplasia in the gall bladder. This is a rare combination of three entities which is being reported for the first time. This case emphasizes that heterotopic pancreas might be the causative factor for cholecystitis.
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Affiliation(s)
- Navjot Kaur
- Department of Pathology, Dr. RP Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Bal Chander
- Department of Pathology, Dr. RP Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Harjit Kaur
- Department of Pathology, Dr. RP Government Medical College, Tanda, Kangra, Himachal Pradesh, India
| | - Rashmi Kaul
- Department of Pathology, Dr. RP Government Medical College, Tanda, Kangra, Himachal Pradesh, India
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Hasan MK, Hawes R, Varadarajulu S. Gastric heterotopic pancreas abscess leading to gastric outlet obstruction. Gastrointest Endosc 2013; 78:550-1. [PMID: 23948200 DOI: 10.1016/j.gie.2013.03.1327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 03/19/2013] [Indexed: 01/16/2023]
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Elhence P, Bansal R, Agrawal N. Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis. Int J Appl Basic Med Res 2013; 2:142-3. [PMID: 23776830 PMCID: PMC3678697 DOI: 10.4103/2229-516x.106360] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Heterotopic pancreatic tissue in the gallbladder is a very uncommon lesion, which is an incidental finding in most cases. We report here, a case of an 18-year-old, post puerperal female, suffering from right upper quadrant abdominal pain with a clinical diagnosis of chronic cholecystitis, in whom heterotopic pancreatic tissue was found in the gall bladder.
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Affiliation(s)
- Poonam Elhence
- Department of Pathology, CSS Hospital, Subharti Medical College, Meerut, India
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Karaca G, Taş A, Pekceci R, Özer H, Köklü S. Unusual Cause of Severe Nausea and Vomiting in an Elderly Man: Heterotopic Pancreas. INT J GERONTOL 2011. [DOI: 10.1016/j.ijge.2011.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Heterotopic pancreatic tissue in the cystic duct: complicating factor or coexisting pathology. South Med J 2010; 103:471-3. [PMID: 20375939 DOI: 10.1097/smj.0b013e3181d839c4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented. Ultrasound showed gallstones without inflammation of the gallbladder. The patient underwent laparoscopic cholecystectomy and her symptoms resolved. Histological examination of the operation specimen disclosed heterotopic pancreatic tissue within the cystic duct. An accurate clinical diagnosis of pancreatic heterotopia is difficult. The deep submucosal or intramural location of the lesion may hamper retrieval of representative biopsy material. Indications for surgery or endoscopic resection include symptomatic lesions as well as cases of unclear histological examination in order to distinguish pancreatic heterotopia from other tumors.
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Elpek GO, Bozova S, Küpesiz GY, Oğüş M. An unusual cause of cholecystitis: heterotopic pancreatic tissue in the gallbladder. World J Gastroenterol 2007; 13:313-315. [PMID: 17226916 PMCID: PMC4065965 DOI: 10.3748/wjg.v13.i2.313] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Revised: 10/23/2006] [Accepted: 12/05/2006] [Indexed: 02/06/2023] Open
Abstract
Gallbladder localization of heterotopic pancreas (HP) is uncommon and very rarely gives rise to symptoms. Herein we report a case of HP found in the gallbladder neck presented with signs and symptoms of cholecystitis. The patient was a 40-year old male, suffering from epigastric pain, abdominal fullness and fever. On physical examination, the right upper abdomen was tender with a positive Murphy's sign. Ultrasonographic examination showed a hydropic gallbladder without stones and he underwent a cholecystectomy. Pathological examination revealed an intramural nodule (9 mm) in the neck region which is consisted of acini, ducts and islet cells of an aberrant pancreatic tissue. Although HP is encountered rarely in the gallbladder and is found incidentally during pathological studies, this case emphasizes that HP might cause symptoms and present clinically as cholecystitis. For this reason, in patients presenting with symptomatic gallbladder diseases, including cholecystitis without any other pathology, HP should be taken into consideration before it is diagnosed as "idiopathic".
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Affiliation(s)
- Gülsüm Ozlem Elpek
- Akdeniz University, Medical School, Department of Pathology, Yeni Tip, Dekanlik, 07070, Antalya, Turkey.
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Murakami M, Tsutsumi Y. Aberrant pancreatic tissue accompanied by heterotopic gastric mucosa in the gall-bladder. Pathol Int 1999; 49:580-2. [PMID: 10469405 DOI: 10.1046/j.1440-1827.1999.00905.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 5 mm pancreatic heterotopia was incidentally identified in the gall-bladder with small cholesterol polyps following cholecystectomy in an asymptomatic 49-year-old female. Microscopically, inflammatory changes in the wall were minimal. The aberrant tissue consisted of acini and ducts but did not have islet formation. Heterotopic gastric mucosal tissue with a mixture of foveolar cells and pyloric glands was seen at the orifice of the pancreatic heterotopia. Islet peptide-immunoreactive endocrine cells were scattered among the pancreatic parenchyma, and the gastric-type gland contained cells positive for gastrin, somatostatin and glucagon. A noteworthy finding was the immunohistochemical detection of a single insulin-containing cell in the pyloric gland.
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Abstract
The main congenital anomalies of the exocrine pancreas are reviewed, and several generalized and isolated hereditary pancreatic diseases are discussed. In contrast with adults, the most frequent causes of acute pancreatitis are viral infection, drug induction, and trauma. The dissimilarities between pediatric and acute and chronic pancreatitis are emphasized.
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Affiliation(s)
- A Lerner
- Department of Pediatrics, Carmel Medical Center, B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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