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Song J, Li S, Xu W, Sun C, Fang Y, Gao B, Li M. Congenital duodenal diaphragm with heterotopic pancreas: a case report and literature review. Front Pediatr 2025; 13:1590865. [PMID: 40443575 PMCID: PMC12121369 DOI: 10.3389/fped.2025.1590865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2025] [Accepted: 04/30/2025] [Indexed: 06/02/2025] Open
Abstract
This case report presents a laparoscopic surgery performed at The Second Hospital of Hebei Medical University for a patient with congenital duodenal diaphragm complicated by heterotopic pancreas (HP). The utilization of indocyanine green (ICG) molecular fluorescent imaging technology and the suspension traction method for duodenal obstruction points during the procedure demonstrates the potential for reducing operational complexity and enhancing surgical success rates. Postoperative feeding via a nasojejunal tube is shown to facilitate rapid restoration of enteral nutrition, mitigate postoperative complications, and decrease the duration of hospitalization.
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Affiliation(s)
| | | | | | | | | | | | - Meng Li
- Department of Paediatric Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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2
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Matran ER, Diaconu AM, Neagu O, Ulmeanu AI. Various Phenotypes of Ectopic Pancreatic Tissue in Children: Case Series and Literature Review. Diagnostics (Basel) 2025; 15:1193. [PMID: 40428186 PMCID: PMC12109883 DOI: 10.3390/diagnostics15101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2025] [Revised: 03/31/2025] [Accepted: 05/02/2025] [Indexed: 05/29/2025] Open
Abstract
Background and Clinical Significance: Ectopic pancreatic tissue (EPT), an infrequently documented condition within the pediatric population, is often asymptomatic. When clinical manifestations do occur, their severity is contingent upon the location, size, and involvement of the adjacent mucosa. Case presentation: This is a case series study, involving six children aged 15 days-13 years diagnosed with EPT from a single institution. Five of the six cases presented with both EPT and ectopic gastric tissue, located at the site of Meckel's diverticulum, while one case presented EPT exclusively, which was localized in the duodenum I. A case of Littre's hernia was identified in a newborn. Two of the six cases experienced gastrointestinal bleeding. Due to limited data on EPT in children, a comprehensive review of the literature was conducted to integrate the findings of the case series. The review synthesized evidence on clinical manifestations, diagnostic approaches, phenotypic classifications, and management strategies. Articles were identified through searches on PubMed and publisher platforms such as Elsevier and Wiley Online Library, using keywords like "ectopic pancreatic tissue", "heterotopic pancreas", and "pediatric ectopic pancreas". Conclusions: The identification of EPT continues to pose a diagnostic challenge, as the symptoms are nonspecific and can sometimes be life-threatening. Additionally, there are currently no specific paraclinical investigations available for this purpose. Histopathological evaluation remains crucial for establishing the diagnosis, which is often confirmed only after complications have arisen.
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Affiliation(s)
- Elena Roxana Matran
- Department of Paediatrics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.R.M.); (A.-I.U.)
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Andra-Mihaela Diaconu
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Hospital for Children, 011743 Bucharest, Romania
| | - Oana Neagu
- Department of Pathology, “Grigore Alexandrescu” Emergency Hospital for Children, 011743 Bucharest, Romania;
| | - Alexandru-Ioan Ulmeanu
- Department of Paediatrics, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.R.M.); (A.-I.U.)
- Department of Pediatrics, “Grigore Alexandrescu” Emergency Hospital for Children, 011743 Bucharest, Romania
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3
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Prager L, Ghayouri M, Abbruzzese TA, Fan J. Jejunal Ectopic Pancreas: A Case Report and Literature Review. Cureus 2025; 17:e83174. [PMID: 40443604 PMCID: PMC12121300 DOI: 10.7759/cureus.83174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2025] [Indexed: 06/02/2025] Open
Abstract
This case report describes a rare etiology of a symptomatic small bowel mass that had been causing our patient spontaneous abdominal pain, nausea, and loss of appetite. The patient is a 53-year-old Caucasian male undergoing chemotherapy and radiation for a nasopharyngeal Epstein-Barr virus-positive carcinoma. He presented to the urgent care with two days of sharp upper abdominal pain and nausea without association of symptoms to prior chemotherapy treatments. Workup initially suggested a jejunal hematoma, which was later revealed to be a mass. The patient underwent outpatient robot-assisted laparoscopic resection of the mass. Pathology demonstrated benign ectopic pancreatic tissue invading through the serosa into the muscularis propria with the sampled lymph nodes negative for malignancy. Ectopic pancreas is a rare congenital abnormality most commonly found in the gastrointestinal tract. Most cases are asymptomatic, but epigastric pain is the most common symptom, followed by nausea, vomiting, and hematochezia. While a benign finding, the index of suspicion for malignancy should remain high as diagnosis can be difficult. Ectopic pancreatic tissue is susceptible to the same pathology that may affect a native pancreas, including pancreatitis and pancreatic malignancy. Radiological and endoscopy studies are useful adjuncts that may increase clinical suspicion; however, it is difficult to differentiate ectopic pancreas from a neoplasm without tissue biopsy. Although no standardized approach exists, surgical resection remains a mainstay of diagnosis and treatment, especially in anatomic locations not amenable to endoscopic intervention.
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Affiliation(s)
- Logan Prager
- General Surgery, HCA Florida Hospital Brandon, Brandon, USA
| | | | | | - Ji Fan
- Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, USA
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Chen Y, Cao Y, Zhi L, Huang R. Endoscopic submucosal dissection combined surgery for the treatment of ectopic gastric mucosa and ectopic pancreas in muscularis propria and serosal layer of the stomach: A rare case report and review of the literature. Medicine (Baltimore) 2025; 104:e41297. [PMID: 40020126 PMCID: PMC11875626 DOI: 10.1097/md.0000000000041297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 01/03/2025] [Indexed: 03/05/2025] Open
Abstract
RATIONALE Ectopic gastric mucosa (EGM) and ectopic pancreas (EP) in the stomach is a rare congenital anomaly. No research on the coexistence of EGM and EP in the stomach has been found. However, several studies have shown canceration of EGM outside the stomach and EP. Active surgical treatment may be necessary. This paper introduces a new case of ectopic gastric mucosa and ectopic pancreas in muscularis propria and serosal layer of the stomach and which were ultimately removed by endoscopic submucosal dissection combined surgery. PATIENT CONCERNS The patient was a 25-year-old male. Upper gastrointestinal endoscopy showed a subepithelial lesion in gastric antrum. DIAGNOSES Postoperative pathology confirmed a diagnosis of EGM and EP. INTERVENTIONS Enhanced computed tomography scan and endoscopic ultrasonography showed a submucosal tumor. Then endoscopic submucosal dissection was performed, during which a lesion was observed on the anterior wall of the stomach near the pylorus. This lesion invades the muscularis propria of the stomach and the large lesions near the pylorus may lead to pyloric obstruction. Considering these situations comprehensively, the patient ultimately underwent surgical resection of gastric lesion and partial gastrectomy. OUTCOMES After 3 months of follow-up, the patient was recovering well and no recurrence of the lesion was found so far. LESSONS EGM along with EP in the stomach is a rare condition. Due to its rarity, there was a lack of sufficient data support for its treatment and prognosis. Due to the EGM and EP may become cancerous, clinical attention should be paid to it. In this study, we present a new case report of EGM along with EP in the stomach and review the existing literature to explore treatment options for it.
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Affiliation(s)
- Yindi Chen
- Department of Gastroenterology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, Shaanxi Province, China
| | - Yanbing Cao
- Department of General Surgery, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, Shaanxi Province, China
| | - Lingran Zhi
- Department of Pathology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, Shaanxi Province, China
| | - Rui Huang
- Department of Gastroenterology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, Shaanxi Province, China
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5
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Turhan MA, Akin FA, Yasaran Benk ZM. Ectopic Pancreatic Tissue in the Gallbladder Following Laparoscopic Cholecystectomy: A Rare Case. Cureus 2025; 17:e79445. [PMID: 39989486 PMCID: PMC11846051 DOI: 10.7759/cureus.79445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2025] [Indexed: 02/25/2025] Open
Abstract
Ectopic pancreatic tissue (EPT) is a rare clinical condition characterized by the presence of pancreatic tissue without any anatomical or vascular connection to the main pancreas. We aim to present a highly unusual case of EPT (fewer than 40 reported cases in the literature), located in the wall of the gallbladder. A 41-year-old female presented with episodes of right upper quadrant and epigastric pain, nausea, and vomiting. Diagnostic imaging revealed multiple gallstones, with the largest measuring 12 mm. The gallbladder wall was normal in thickness, and there were no abnormalities in the liver, bile ducts, spleen, or pancreas. Laboratory tests were normal, except for iron-deficiency anemia. Amylase and lipase levels were within normal limits. The patient underwent an uncomplicated elective laparoscopic cholecystectomy. Pathological examination of the gallbladder revealed chronic cholecystitis and EPT classified as type 3 EPT according to the Gaspar Fuentes classification. Due to its various clinical presentations and the low discriminative power of routine imaging tests, preoperative diagnosis of EPT is nearly impossible. However, considering the potential for malignant transformation and complications of EPT, physicians should be aware of this clinical entity and consider cholecystectomy when there is a high degree of suspicion. EPT in the gallbladder is an extremely rare finding. Patients are either asymptomatic or present with nonspecific symptoms, and the definitive diagnosis is almost always made through pathological examination following cholecystectomy.
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Affiliation(s)
| | - Furkan Atakan Akin
- General Surgery, Yildirim Beyazit University Yenimahalle Training and Research Hospital, Ankara, TUR
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Kim M, Yang J, Song D, An H, Kim D. Mixed Pancreatobiliary Ductal Adenocarcinoma and Squamous Cell Carcinoma Arising from an Ectopic Pancreas in a Gastric Duplication Cyst-A Rare Double Diagnosis. Diagnostics (Basel) 2024; 14:2727. [PMID: 39682635 DOI: 10.3390/diagnostics14232727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Revised: 11/26/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
Gastric duplication cysts (GDCs) are rare congenital anomalies, often identified during infancy or childhood. Although typically benign, there have been sporadic reports of malignant transformations, including adenocarcinoma and rare mixed tumors. Herein, we describe a rare case of mixed pancreatobiliary ductal adenocarcinoma and squamous cell carcinoma occurring within a GDC in a 54-year-old Korean woman with a history of melena and hematemesis. Initial gastroscopy and positron emission tomography-computed tomography (PET-CT) revealed a protruding stomach mass. A laparoscopic total gastrectomy was performed, and histological examination confirmed a mixed carcinoma originating from an ectopic pancreas within the duplication cyst. This case is unique as it is the first reported instance in the world of mixed pancreatobiliary ductal adenocarcinoma and squamous cell carcinoma arising from an ectopic pancreas within a GDC. This highlights the importance of considering pancreatobiliary-type adenocarcinoma in the differential diagnosis of malignancies originating from GDCs, which has implications for treatment strategies.
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Affiliation(s)
- Minhye Kim
- Department of Pathology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
| | - Jungwook Yang
- Department of Pathology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
| | - Daehyun Song
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Hyojung An
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea
| | - Dongchul Kim
- Department of Pathology, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea
- Institute of Medical Science, Gyeongsang National University, Jinju 52727, Republic of Korea
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Byrnes K, Kang L, Sappenfield R, Liu X. Heterogeneity of pancreatic neoplasms arising in pancreatic heterotopia: a single institution review. Virchows Arch 2024:10.1007/s00428-024-03992-5. [PMID: 39613894 DOI: 10.1007/s00428-024-03992-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 10/31/2024] [Accepted: 11/23/2024] [Indexed: 12/01/2024]
Abstract
Pancreatic heterotopia (PH) is a well-characterized entity that can arise in the gastrointestinal tract. Many pancreatic disease processes, ranging from inflammatory to neoplastic, can also be seen in PH. Neoplastic transformation in PH remains exceedingly rare. A retrospective review of PH cases (1990 to 2020) excised at our institution was performed. Cases were selected based on prior criteria for identifying neoplastic transformation in PH. Clinical information was obtained through the electronic medical record. A total of 163 gastrointestinal tract PH cases were identified. Of these, seven had a neoplastic process in the heterotopic pancreas: two with well-differentiated neuroendocrine tumors, three with pancreatic intraepithelial neoplasia, and one each developed ductal adenocarcinoma or neuroendocrine microadenoma. The majority were men (71.4%) with a median age of 64 years. Seven patients had clinical symptoms including weight loss, abdominal pain, and small bowel obstruction. Five cases arose in the small intestine and two cases arose in the stomach. Lesions involved the submucosa (42.8%), serosa (28.6%), and muscularis propria (28.6%). In all cases, the PH was composed of acini, ducts, and islet cells. The mean follow-up time was 55 months (range: 3-159 months). One patient had regional lymph node metastasis and died with disease from surgical complications. No cases of distant metastasis were identified. Neoplasia in PH is a rare phenomenon that can occur, including malignant entities such as ductal adenocarcinoma, but also other tumor types. Recognition of this entity remains important for pathologists to avoid diagnostic confusion and provide accurate tumor staging.
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Affiliation(s)
- Kathleen Byrnes
- Department of Pathology and Immunology, Washington University in St. Louis, 660 South Euclid Avenue, Campus, Box 8118, St. Louis, MO, 63110, USA.
| | - Liang Kang
- Department of Pathology and Immunology, Washington University in St. Louis, 660 South Euclid Avenue, Campus, Box 8118, St. Louis, MO, 63110, USA
| | - Ryan Sappenfield
- Department of Pathology and Immunology, Washington University in St. Louis, 660 South Euclid Avenue, Campus, Box 8118, St. Louis, MO, 63110, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, 53705, USA
| | - Xiuli Liu
- Department of Pathology and Immunology, Washington University in St. Louis, 660 South Euclid Avenue, Campus, Box 8118, St. Louis, MO, 63110, USA
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8
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Lin Y, Wang FT, Jiao YR, Chen CQ. Ileal ectopic pancreas with malignant transformation in a patient with Crohn's disease. Asian J Surg 2024:S1015-9584(24)02613-7. [PMID: 39613633 DOI: 10.1016/j.asjsur.2024.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Revised: 10/22/2024] [Accepted: 11/04/2024] [Indexed: 12/01/2024] Open
Affiliation(s)
- Yin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Fang-Tao Wang
- Diagnostic and Treatment Center for Refractory Diseases of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi-Ran Jiao
- Diagnostic and Treatment Center for Refractory Diseases of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun-Qiu Chen
- Diagnostic and Treatment Center for Refractory Diseases of Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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9
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Costa D, Ramai D, Tringali A. Novel classification of gastric polyps: The good, the bad and the ugly. World J Gastroenterol 2024; 30:3640-3653. [PMID: 39192997 PMCID: PMC11346164 DOI: 10.3748/wjg.v30.i31.3640] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024] Open
Abstract
Gastric polyps (GPs) are increasingly common. On upper endoscopy, they should be examined with white light and occasionally chromoendoscopy, and their morphology classified according to the Paris classification. Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection. Histological examination is necessary for an accurate diagnosis. While most polyps are non-neoplastic and do not require treatment, some carry a risk of malignancy or are already malignant. Therefore, understanding the diagnosis, classification, and management of GPs is crucial for patient prognostication. Our new classification categorizes GPs into "good", "bad", and "ugly" based on their likelihood of becoming malignant. We aim to provide descriptions of the endoscopic appearance, pathology, treatment, and follow-up for different GPs, as well as clinical management flowcharts.
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Affiliation(s)
- Deborah Costa
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
| | - Daryl Ramai
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Alberto Tringali
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
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10
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Costa D, Ramai D, Tringali A. Novel classification of gastric polyps: The good, the bad and the ugly. World J Gastroenterol 2024; 30:3640-3653. [DOI: doi 10.3748/wjg.v30.i31.3640 pmid: 39192997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2025] Open
Abstract
Gastric polyps (GPs) are increasingly common. On upper endoscopy, they should be examined with white light and occasionally chromoendoscopy, and their morphology classified according to the Paris classification. Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection. Histological examination is necessary for an accurate diagnosis. While most polyps are non-neoplastic and do not require treatment, some carry a risk of malignancy or are already malignant. Therefore, understanding the diagnosis, classification, and management of GPs is crucial for patient prognostication. Our new classification categorizes GPs into "good", "bad", and "ugly" based on their likelihood of becoming malignant. We aim to provide descriptions of the endoscopic appearance, pathology, treatment, and follow-up for different GPs, as well as clinical management flowcharts.
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11
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Wang T, Jiang J, Guo LL, Chen X, Chen EB. Heterotopic pancreas in the gallbladder: A case report. World J Clin Cases 2024; 12:5140-5144. [PMID: 39109006 PMCID: PMC11238770 DOI: 10.12998/wjcc.v12.i22.5140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/19/2024] [Accepted: 06/05/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Heterotopic pancreas (HP) refers to pancreatic tissue located in areas with no vascular or anatomical connection to the pancreas. HP occurs mostly in the stomach, duodenum, and colon, and rarely in the gallbladder. CASE SUMMARY A 57-year-old woman was referred to our hospital complaining of right upper quadrant discomfort for 3 years. An abdominal computed tomography scan revealed adenomyomatosis with a thickened fundus of the gallbladder. The patient underwent a laparoscopic cholecystectomy, and pathological examination unexpectedly showed heterotopic pancreatic tissue in the gallbladder. The patient had a favorable recovery and was discharged on postoperative day 3. She did not report any symptoms or complications at the 6-mo postoperative follow-up. Pathologists should pay close attention to such pancreatic tissue and carefully examine it for dysplasia or malignancy. CONCLUSION This case provides more information about HP in the gallbladder, a rare occurrence.
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Affiliation(s)
- Ting Wang
- Department of Hepatobiliary and Pancreatic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Jing Jiang
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Ling-Ling Guo
- Department of Radiation Oncology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Xu Chen
- Department of Hepatobiliary and Pancreatic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
| | - Er-Bao Chen
- Department of Hepatobiliary and Pancreatic Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong Province, China
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12
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Okamura K, Ishibashi E, Araki K, Kanasaki Y, Kodama K, Kanazawa A, Onuma H. Acute on chronic pancreatitis affecting the ectopic pancreas located in the jejunal mesentery: A case report. Acta Radiol Open 2024; 13:20584601241269617. [PMID: 39091590 PMCID: PMC11289796 DOI: 10.1177/20584601241269617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/13/2024] [Accepted: 07/01/2024] [Indexed: 08/04/2024] Open
Abstract
Ectopic pancreas within the mesentery is rare. In this case report, a 61-year-old man with an ectopic pancreas within the jejunal mesentery for over 20 years developed chronic pancreatitis that progressed to acute exacerbation. Our computed tomography (CT) performed for acute abdomen assessment suggested acute appendicitis or Meckel's diverticulitis. However, a CT scan taken 20 years ago revealed a structure indicative of an ectopic pancreas in the mesentery, and further imaging findings taken 10 and 4 years ago confirmed progression to chronic pancreatitis. Furthermore, we found a pancreatic stone confined in the luminal structure that corresponded to the main pancreatic duct; this stone eventually caused acute exacerbation. In summary, we report a case of mesenteric ectopic pancreas that showed typical findings of progression and acute exacerbation of chronic pancreatitis on CT.
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Affiliation(s)
- Kazuya Okamura
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Emi Ishibashi
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kazumi Araki
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Yoshiko Kanasaki
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Koji Kodama
- Department of Radiology, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Akiyoshi Kanazawa
- Department of Gastrointestinal Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Hideyuki Onuma
- Department of Diagnostic Pathology, Shimane Prefectural Central Hospital, Izumo, Japan
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13
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Iwuagwu CC, Jensen L, Parikh J, Zayat V. A Case Report of an Unusually Large Heterotopic Pancreas. Cureus 2024; 16:e64228. [PMID: 39007019 PMCID: PMC11239240 DOI: 10.7759/cureus.64228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2024] [Indexed: 07/16/2024] Open
Abstract
Heterotopic pancreas (HP) is the presence of pancreatic tissue outside of its normal anatomical position without vascular continuity from the main pancreas. HP is most commonly found within the gastrointestinal tract, particularly the stomach through the jejunum. This report shares the case of a 57-year-old man who presented with persistent vomiting despite medical therapy. Given the nonspecific and broad differential diagnosis, a histopathological examination was warranted for a definitive diagnosis that showed a uniquely large and well-differentiated type I HP in the lesser curvature of the stomach. Resection was completed which was followed with resolution of symptoms.
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Affiliation(s)
- Cindy C Iwuagwu
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Lillie Jensen
- College of Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Vania Zayat
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
- Pathology, University of Central Florida College of Medicine, Orlando, USA
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Yang X, Liu C, Sun S, Dong C, Zhao S, Bokhary ZM, Liu N, Wu J, Ding G, Zhang S, Geng L, Liu H, Fu T, Gao X, Niu Q. Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study. Pediatr Surg Int 2024; 40:141. [PMID: 38811418 PMCID: PMC11136705 DOI: 10.1007/s00383-024-05722-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.
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Affiliation(s)
- Xiaofeng Yang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Liu
- Department of Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Sun
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Dong
- Department of General Surgery, Zibo Hospital of Shandong Yiyang Health Industry Development Group Co, Ltd, Zibo, China
| | - Shanshan Zhao
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zaitun M Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Na Liu
- Department of Pathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Jinghua Wu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Xiangqian Gao
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China.
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China.
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15
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Qi R, Li K, Shi B. Adenocarcinoma developing from gastric heterotopic pancreas: a case report and short review. Front Surg 2024; 11:1274389. [PMID: 38783861 PMCID: PMC11111919 DOI: 10.3389/fsurg.2024.1274389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.
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Affiliation(s)
- Ran Qi
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China
| | - Kun Li
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Baomin Shi
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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16
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Kimura T, Minato Y, Banjoya S, Iida T, Furuta K, Nagae S, Ito Y, Yamazaki H, Takeuchi N, Takayanagi S, Kimoto Y, Kano Y, Sakuno T, Ono K, Miura S, Morikawa T, Ohata K. Endoscopic management of gastric ectopic pancreas with repeated ulcerations and bleeding: A case report. DEN OPEN 2024; 4:e338. [PMID: 38283588 PMCID: PMC10821752 DOI: 10.1002/deo2.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Abstract
A 25-year-old man was referred to our center for investigation of a gastric submucosal tumor and an ulcer that had developed on its oral side. Endoscopic ultrasonography findings suggested the presence of an ectopic pancreas, and treatment with an oral proton pump inhibitor was planned for the ulcer. Over the subsequent 3 years, the patient endured recurring epigastric pain and episodes of passing black stools. Emergency endoscopy revealed that the morphology of the gastric submucosal tumor had transformed into a pedunculated polyp-like morphology with a bleeding ulcer at the apex of the lesion. Endoscopic hemostasis using hemostatic forceps was performed. However, the patient continued to pass black stools. In light of the persistent symptoms and unique morphology of the lesion, endoscopic resection was attempted as a curative approach. The lesion was excised by hot snare polypectomy. Post-treatment, the patient exhibited no signs of recurrence, marking a successful resolution. Three months later, a gastroduodenal endoscopy showed that the excised site had undergone scar formation without recurrence of the lesion. This case holds significant clinical value as it demonstrates the efficacy of a minimally invasive treatment strategy in managing repeated bleeding ulcerations of an ectopic pancreas, ultimately achieving a complete cure.
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Affiliation(s)
- Tomoya Kimura
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yohei Minato
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Susumu Banjoya
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Toshifumi Iida
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Koichi Furuta
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Shinya Nagae
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yohei Ito
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Hiroshi Yamazaki
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Nao Takeuchi
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Shunya Takayanagi
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yoshiaki Kimoto
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Yuki Kano
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Takashi Sakuno
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Kohei Ono
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
| | - Sakiko Miura
- Department of Diagnostic PathologyNTT Medical Center TokyoTokyoJapan
| | - Teppei Morikawa
- Department of Diagnostic PathologyNTT Medical Center TokyoTokyoJapan
| | - Ken Ohata
- Department of Gastrointestinal EndoscopyNTT Medical Center TokyoTokyoJapan
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17
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Bocciarelli C, Poureau PG, Uguen A, Doucet L. [Morphological and immunophenotypical confrontation in the diagnosis of a rare gastric tumor]. Ann Pathol 2024; 44:78-81. [PMID: 37659879 DOI: 10.1016/j.annpat.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/02/2023] [Indexed: 09/04/2023]
Affiliation(s)
- Claire Bocciarelli
- Service d'anatomie et cytologie pathologiques, hôpital Morvan, CHRU de Brest, 5, avenue Foch, 29609 Brest, France
| | | | - Arnaud Uguen
- Service d'anatomie et cytologie pathologiques, hôpital Morvan, CHRU de Brest, 5, avenue Foch, 29609 Brest, France; Université de Brest, Inserm, CHU de Brest, LBAI, UMR1227, Brest, France.
| | - Laurent Doucet
- Service d'anatomie et cytologie pathologiques, hôpital Morvan, CHRU de Brest, 5, avenue Foch, 29609 Brest, France
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18
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Ji X, Dong A, Wang Y. FDG PET/CT in Pancreatic Ductal Adenocarcinoma Arising From a Heterotopic Pancreas of the Pylorus. Clin Nucl Med 2024; 49:e42-e44. [PMID: 37976432 DOI: 10.1097/rlu.0000000000004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
ABSTRACT Malignant transformation of heterotopic pancreas is extremely rare. We describe FDG PET/CT findings in a case of pancreatic ductal adenocarcinoma arising from a heterotopic pancreas in the submucosa of the pylorus with peripyloric lymph node metastasis and elevated serum carbohydrate antigen 19-9 level. The heterotopic pancreatic adenocarcinoma showed intense FDG uptake, and the peripyloric lymph node metastasis showed mild FDG uptake. This case indicates that heterotopic pancreatic adenocarcinoma should be included in the differential diagnosis of FDG-avid gastric submucosal lesions, especially in patients with elevated serum carbohydrate antigen 19-9 level.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Naval Medical University
| | - Yang Wang
- Department of Pathology, Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
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19
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Bullock C, Amiraian D, Almerey T, Stauffer J, Komforti MK, LeGout JD. The tale of 2 pancreases: Jejunal mesenteric ectopic pancreas causing recurrent ectopic pancreatitis. Radiol Case Rep 2024; 19:464-467. [PMID: 38046919 PMCID: PMC10692469 DOI: 10.1016/j.radcr.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Ectopic pancreas, or the presence of pancreatic tissue separate from the anatomic pancreas, is rarely reported in locations other than the stomach or duodenum. A 43-year-old female was found to have a large jejunal mesenteric ectopic pancreas causing ectopic pancreatitis during workup for frequent episodes of abdominal pain. We present the imaging findings and postresection pathology findings of a rare jejunal ectopic pancreas and discuss the potential complications of this unique condition.
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Affiliation(s)
| | - Dana Amiraian
- Department of Radiology, Mayo Clinic Jacksonville FL, USA
| | - Tariq Almerey
- Department of Surgery, Mayo Clinic Jacksonville FL, USA
| | - John Stauffer
- Department of Surgery, Mayo Clinic Jacksonville FL, USA
| | - Miglena K. Komforti
- Department of Pathology and Laboratory Medicine, Mayo Clinic Jacksonville FL, USA
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20
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Yoshikawa C, Migita K, Yamato I, Ueno M, Kashizuka H, Murakami K, Ishikawa H. Acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, in an adult with intestinal malrotation: a case report. Surg Case Rep 2023; 9:150. [PMID: 37638994 PMCID: PMC10462583 DOI: 10.1186/s40792-023-01736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Intestinal duplication and ectopic pancreas are two rare independent congenital anomalies. Few reports describe cases of patients with ectopic pancreas in an intestinal duplication causing acute peritonitis. CASE PRESENTATION A 31-year-old man was admitted to the hospital for epigastric pain. The patient was diagnosed with acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication, with intestinal malrotation. The patient underwent the partial resection of the jejunum and Ladd's procedure. The histopathological findings indicated ectopic pancreatitis in the jejunal duplication. CONCLUSIONS We presented the case of acute peritonitis caused by the acute pancreatitis of an ectopic pancreas in a jejunal duplication in an adult with intestinal malrotation. Surgery is the primary treatment and is necessary for a definitive diagnosis.
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Affiliation(s)
- Chihiro Yoshikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan.
| | - Kazuhiro Migita
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Ichiro Yamato
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Masato Ueno
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hisanori Kashizuka
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Koichi Murakami
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
| | - Hirofumi Ishikawa
- Department of Surgery, Nara Prefecture Seiwa Medical Center, 1-14-16 Mimuro Sango-Cho Ikoma-Gun, Nara, 636-0802, Japan
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21
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Ciardiello D, Urbano F, Zamboni G, Palladino N, Bazzocchi F, Parente P. Left abdominal mass with carcinosis: Unusual presentation of pancreatic acinar cell carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:412-414. [PMID: 36307307 DOI: 10.1016/j.hbpd.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/29/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Davide Ciardiello
- Oncology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Filomena Urbano
- Radiology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Giuseppe Zamboni
- Pathology Unit, Ospedale Sacro Cuore Don Calabria, vai Sempreboni, Negrar and University of Verona, Negrar 37024, VR, Italy
| | - Nicola Palladino
- Radiology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Francesca Bazzocchi
- Abdominal Surgical Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Ospedale Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo 71013, Italy.
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22
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Chen M, Tanaka T, Igawa T, Han Y, Peng F, Jin Z, Yoshino T. Expression and clinicopathological characteristics of PDX1, PTF1A, and SALL4 in large and small ducts of ectopic pancreas located in gastro-duodenum and jejunum. Heliyon 2023; 9:e18241. [PMID: 37519669 PMCID: PMC10372316 DOI: 10.1016/j.heliyon.2023.e18241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/26/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
An ectopic pancreas is defined as pancreatic tissue outside its normal location, anatomically separated from the pancreas. The transcription factor pancreas/duodenum homeobox protein 1 (PDX1) is involved in maintaining the pancreas and functions in early pancreatic development, beta cell differentiation, and endocrine non beta cells. Pancreatic transcription factor 1 subunit alpha (PTF1A) affects exocrine cell formation and regulation of acinar cell identity, and is expressed in exocrine cells as a transcription factor. The depletion of SALL4 disrupts self-renewal and induces differentiation. To clarify which of PDX1, PTF1A, or SALL4 determines the difference in Heinrich's classification, we examined the localization and number of positive cells. We analyzed the differential expression of PDX1, PTF1A, and SALL4 in large and small ducts in ectopic pancreas by immunohistochemistry. Results showed that the number of PTF1A-positive cells in large ducts was more widespread in type I than in type II in the gastro-duodenum, and more SALL4-positive cells were noticed in large ducts than in small ducts in the gastro-duodenum of type II. Our results revealed that PTF1A might promote exocrine differentiation in developing the pancreatic tissues, and that those with widespread expression differentiate into exocrine cells.
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Affiliation(s)
- Mengxi Chen
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Takuro Igawa
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Yanyan Han
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Fangli Peng
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Zaishun Jin
- Department of Pathology, Mudanjiang Medical University, Mudanjiang, 157001, China
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
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23
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Yano R, Yokota T, Morita M, Amano M, Ochi H, Azemoto N, Mashiba T, Joko K. Metastasis from Renal Cell Carcinoma to Ectopic Pancreas Diagnosed after Resection. Intern Med 2023; 62:1011-1015. [PMID: 36047115 PMCID: PMC10125805 DOI: 10.2169/internalmedicine.9731-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 68-year-old man who underwent nephrectomy for right renal cell carcinoma 10 years prior. He remained under regular medical observation, and abdominal computed tomography showed tumors in the head and tail of the pancreas. He was diagnosed with pancreatic metastasis from renal cell carcinoma. He underwent surgical excision. The pathologic diagnosis proved that the pancreatic tumors were metastases from renal cell carcinoma and clarified that an ectopic pancreas in the duodenum had metastases as well. To our knowledge, this is the first case of metastasis to an ectopic pancreas.
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Affiliation(s)
- Ryo Yano
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Tomoyuki Yokota
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Makoto Morita
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Michiko Amano
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Hironori Ochi
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Nobuaki Azemoto
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Toshie Mashiba
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
| | - Koji Joko
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Japan
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24
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Conti CB, Mulinacci G, Tamini N, Jaconi M, Zucchini N. Colonic ductal adenocarcinoma case report: New entity or rare ectopic degeneration? World J Gastrointest Endosc 2023; 15:191-194. [PMID: 37034967 PMCID: PMC10080554 DOI: 10.4253/wjge.v15.i3.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 02/08/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features. Currently, the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.
CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia, with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values. She underwent laparoscopic right hemicolectomy. The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern. Benign ectopic pancreatic tissue was absent in the surgical specimen.
CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue. However, the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.
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Affiliation(s)
| | - Giacomo Mulinacci
- Interventional Endoscopy, ASST Monza, Ospedale San Gerardo, Monza 20900, Italy
| | - Nicolò Tamini
- Department of Surgery, ASST Monza, Ospedale San Gerardo, Monza 20900, Italy
| | - Marta Jaconi
- Department of Pathology, ASST Monza, Ospedale San Gerardo, Monza 20900, Italy
| | - Nicola Zucchini
- Department of Pathology, ASST Monza, Ospedale San Gerardo, Monza 20900, Italy
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25
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Zhang X, Peng L, Wang Z, Pan F, Ren R, Li Y, Zhang X. Extensive heterotopic pancreas in a rare site: A case report and a review of literature. Medicine (Baltimore) 2023; 102:e32241. [PMID: 36862885 PMCID: PMC9981405 DOI: 10.1097/md.0000000000032241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/18/2022] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Heterotopic pancreas is a pancreatic tissue that occurs outside the normal anatomical site, the most common site is antrum. Due to the lack of specific imaging and endoscopic signs, heterotopic pancreas especially those occurring in the rare site, are often misdiagnosed, and leading to unnecessary surgical treatment. Endoscopic incisional biopsy and endoscopic ultrasound-guided fine-needle aspiration are effective means for diagnosing heterotopic pancreas. We reports a case of extensive heterotopic pancreas in a rare site, which was finally diagnosed by this way. PATIENT CONCERNS A 62-year-old man was admitted due to the presence of an angular notch lesion, which was suspected as gastric cancer before. He denied any history of tumor or gastric disease. DIAGNOSES No abnormality was found in the physical examination and laboratory testing after admission. Computed tomography showed localized thickening of the gastric wall measuring 30 mm in the long diameter. Gastroscope revealed a nodular-like submucosal protuberance at the angular notch with size of about 3*4 cm. Ultrasonic gastroscope showed that the lesion was located in the submucosa. The lesion exhibited mixed echogenicity. The diagnosis can not be identified. INTERVENTIONS 2 times of incision biopsy were performed to make a clear diagnosis. Finally, appropriate tissue specimens were obtained for pathology testing. OUTCOMES The patient was diagnosed as heterotopic pancreas according to pathology. He was recommended to undergo observation and regular follow-ups rather than surgery. Then he was discharged home with no discomfort. LESSONS Heterotopic pancreas occurring in the angular notch is extremely rare, the site is scarcely reported in the relevant literature. Therefore, it is easy to be misdiagnosed. In the cases of an vague diagnosis, endoscopic incisional biopsy or endoscopic ultrasound-guided fine-needle aspiration may be a good choice.
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Affiliation(s)
- Xiaohan Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Lihua Peng
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Pan
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Rongrong Ren
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Li
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiuli Zhang
- Department of Gastroenterology and Hepatology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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26
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Petrauskas V, Stulpinas R, Mickys U, Luksaite-Lukste R, Strupas K, Poskus E. Aberrant pancreas adenocarcinoma in the stomach: A case report and literature review. Medicine (Baltimore) 2023; 102:e32642. [PMID: 36637936 PMCID: PMC9839233 DOI: 10.1097/md.0000000000032642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 01/14/2023] Open
Abstract
RATIONALE Aberrant pancreatic tissue in the gastrointestinal tract is a relatively common finding. However, malignant transformation is extremely rare. Herein, we report a case of ectopic pancreatic ductal adenocarcinoma in the stomach wall. PATIENT CONCERNS A 38 year old male presented with nausea, bloating, abdominal distention and weight loss for 4 months. DIAGNOSES Endoscopy of upper gastrointestinal tract was performed twice with 2 months interval and a stenotic pyloric part was observed with a suspected submucosal lesion. It was sampled both times, however the pathology findings of the mucosal biopsies were unremarkable with no identifiable neoplastic structures. CT scan and MRI was performed and showed a thickened pyloric wall with a submucosal lesion 15 × 15 mm in diameter. Blood levels of tumor markers carcinoembrionic antigen and carbohydrate antigen 19-9 were within a normal range. INTERVENTIONS Pyloric stenosis progressed and the patient underwent a Billroth type I distal gastric resection with D2 lymphadenectomy. Pathologic examination revealed a well differentiated ductal adenocarcinoma arising in the heterotopic pancreatic tissue (Heinrich type III). The resection margins and lymph nodes were free of tumor. The patient received adjuvant chemotherapy with 6 courses of XELOX. OUTCOMES No disease recurrence is reported in 12 months follow-up. LESSONS Aberrant pancreatic ductal adenocarcinoma in the stomach is a rare finding, however this pathology should be included in the differential diagnosis of gastric submucosal lesion causing pyloric stenosis.
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Affiliation(s)
- Vidas Petrauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Abdominal and Oncological surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rokas Stulpinas
- Centre of Abdominal and Oncological surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ugnius Mickys
- Centre of Abdominal and Oncological surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Raminta Luksaite-Lukste
- National Centre of Pathology, Affiliate of Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Zhang T, Yin SF, Wang QW, Feng WB, Ke CX. Case Report: The ectopic pancreas in the adrenal glands: It was found due to elevated blood pressure and initially diagnosed as adrenal adenoma. Front Surg 2022; 9:1040711. [PMID: 36406378 PMCID: PMC9669272 DOI: 10.3389/fsurg.2022.1040711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background The ectopic pancreas is a kind of congenital malformation formed during embryonic development, which has no anatomical relationship with the normal pancreas and is a rare solid disease. The ectopic pancreas in the adrenal glands is extremely rare. Case summary A 32-year-old man was admitted to the hospital after experiencing elevated blood pressure for 2 years as well as dizziness and blurred vision for 2 weeks. He had an elevated blood pressure of 170/110 mmHg (1 mmHg = 0.133 kPa) on physical examination 2 years ago, without palpitations, chest pain, and chest tightness. Two weeks ago, he presented with dizziness and blurred vision. Blood renin and aldosterone levels were elevated. Plain CT and contrast-enhanced CT scan showed nodular thickening of the left adrenal and homogeneous enhancement, which was initially considered adrenal adenoma. The postoperative pathology supported the ectopic pancreas in the left adrenal. After 78 months of postoperative follow-up, no recurrence was observed, but his blood pressure remained persistently high. Conclusion The ectopic pancreas occurring in the adrenal glands is extremely rare, has no specific clinical symptoms, and is mainly found for other reasons. It can easily be misdiagnosed as an adrenal adenoma. The final confirmation of the diagnosis still depends on the pathological biopsy. A great deal of reporting is still required for whether there is a correlation with elevated blood pressure.
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Affiliation(s)
- Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Si-fan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qi-wu Wang
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Wen-bo Feng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Correspondence: Chang-Xing Ke
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Kim JE, Lee JH, Park S, Lee KH, Kim TJ, Min YW, Lee H, Min BH, Rhee PL, Kim JJ. Ectopic Pancreas with Walled-off Necrosis Mimicking Malignant Submucosal Gastric Tumor. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 80:195-199. [DOI: 10.4166/kjg.2022.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ji Eun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sujin Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwang Hyuck Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Jun Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyuk Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Poong-Lyul Rhee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae J Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sun Z, Chen T, Zhu X, Geng J, Sui C, Zhang N, Guo L. Case report of retroperitoneal ectopic pancreas with adrenal adenoma. Front Surg 2022; 9:935211. [PMID: 36743901 PMCID: PMC9891801 DOI: 10.3389/fsurg.2022.935211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/16/2022] [Indexed: 01/19/2023] Open
Abstract
Background Ectopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separated from the main gland and without vascular or ductal continuity. A case of retroperitoneal ectopic pancreas with adrenal adenoma has never yet been reported. Case Presentation A 54-year-old man presented three masses in the left retroperitoneum, and two of them were resected. The pathologic findings were a retroperitoneal ectopic pancreas with adrenal adenoma. Conclusion We report an extremely rare case of a retroperitoneal ectopic pancreas and its characterization with dynamic gadolinium-enhanced magnetic resonance imaging (MRI).
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Affiliation(s)
- Zhaochen Sun
- Graduate School, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Chen
- Clinical Laboratory, Jinan Maternal and Child Care Hospital, Jinan, China
| | - Xuefeng Zhu
- Department of Radiology, Zouping People's Hospital of Shandong Province, Zouping, China
| | - Jie Geng
- Department of Director's Office, JinanMunicipal Health Commission, Jinan, China
| | - Chaofan Sui
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Nan Zhang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,Correspondence: Lingfei Guo, Nan Zhang
| | - Lingfei Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China,Correspondence: Lingfei Guo, Nan Zhang
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30
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Chin NH, Wu JM, Chen KC, Lee TH, Lin CK, Chung CS. Pancreatic Heterotopia in the Small Bowel: A Case Report and Literature Review. Pancreas 2022; 51:700-704. [PMID: 36206472 DOI: 10.1097/mpa.0000000000002061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT Diagnosing pancreatic heterotopia (PH) is challenging, because it is a rare congenital anomaly. We report the case of a 66-year-old man who presented with ileus and jejunal PH diagnosed using single-balloon enteroscopy. Reviewing 178 cases of small intestinal PH in the literature showed that (1) PH mostly occurred at the duodenum (61.8%), followed by the jejunum (22.5%) and ileum (14.6%); (2) patients with ileal PH were younger (mean, 40.7 vs 54.6 years; P < 0.001), while those with jejunal PH were older (mean, 59.5 vs 51.7 years; P = 0.006); (3) most patients with jejunal PH were females, while those with duodenal or ileal PH were predominantly males (M:F = 0.8:1 vs 2.5:1; P = 0.003); (4) asymptomatic cases were rare (15.2% vs 83.4% in small and nonsmall bowel, respectively); (5) most patients with ileal PH presented with bleeding (61.5%), while the remaining had abdominal pain (42.8%); (6) emergent operation was performed in 11 cases (6.2%), mainly at the jejunum (12.5%) and Meckel's diverticulum (25%); and (7) Heinrich's classification may be inconclusive. Enteroscopy was performed in only 6 cases (3.4%), and earlier diagnosis and further minimally invasive procedures could have been achieved with enteroscopy.
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Affiliation(s)
- Ning-Hsuan Chin
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Jiann-Ming Wu
- Department of Surgery, Far Eastern Memorial Hospital
| | - Kuan-Chih Chen
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Tzong-Hsi Lee
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
| | - Cheng-Kuan Lin
- From the Division of Gastroenterology and Hepatology, Department of Internal Medicine
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31
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Li S, Gao M, Tao L, Luo G, Gao Q, Qian K, Deng L. Clusters of malignant cysts in the gastric submucosal layer (with video). Endosc Ultrasound 2022; 11:518-519. [PMID: 36537391 PMCID: PMC9921984 DOI: 10.4103/eus-d-21-00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Affiliation(s)
- Shan Li
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Minna Gao
- Department of Pathology, Chongqing Medical University, Chongqing, China
| | - Li Tao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guomin Luo
- Department of Oncology, Yongchuan Hospital, Chongqing Medical University, Chongqing, China
| | - Qing Gao
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Address for correspondence Dr. Liang Deng, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
Dr. Kun Qian, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
| | - Liang Deng
- Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Address for correspondence Dr. Liang Deng, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
Dr. Kun Qian, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China. E-mail:
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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: 0.3] [Reference Citation Analysis] [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.
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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.
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The Diagnosis of Small Gastrointestinal Subepithelial Lesions by Endoscopic Ultrasound-Guided Fine Needle Aspiration and Biopsy. Diagnostics (Basel) 2022; 12:diagnostics12040810. [PMID: 35453857 PMCID: PMC9027519 DOI: 10.3390/diagnostics12040810] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Endoscopic ultrasonography (EUS) has been widely accepted in the diagnosis of all types of tumors, especially pancreatic tumors, lymph nodes, and subepithelial lesions (SELs). One reason is that the examination can provide a detailed observation, with tissue samples being immediately obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). Many SELs are detected incidentally during endoscopic examinations without symptoms. Most SELs are mesenchymal tumors originating from the fourth layer, such as gastrointestinal stromal tumors (GISTs), leiomyomas, and schwannomas. GISTs are potentially malignant. Surgical treatment is recommended for localized GISTs of ≥20 mm. However, the indications for the diagnosis and follow-up of GISTs of <20 mm in size are controversial. There are several reports on the rapid progression or metastasis of small GISTs. Therefore, it is important to determine whether a SEL is a GIST or not. The main diagnostic method is EUS-FNA. Recently, endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a new biopsy needle has been reported to obtain larger tissue samples. Additionally, various biopsy methods have been reported to have a high diagnostic rate for small GISTs. In local gastric SELs, regardless of the tumor size, EUS can be performed first; then, EUS-FNA/B or various biopsy methods can be used to obtain tissue samples for decision-making in relation to therapy and the follow-up period.
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34
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Yang Y, Liu Y, Dai L, Yan W, Liang Z, Chen K. Malignant transformation of heterotopic pancreas as middle esophagus adenocarcinoma—A rare case report and comprehensive literature review. Thorac Cancer 2022; 13:1083-1087. [PMID: 35253375 PMCID: PMC8977157 DOI: 10.1111/1759-7714.14344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/03/2023] Open
Abstract
Heterotopic pancreas is a rare congenital abnormality that occurs during the growth and development process. It can be found in any part of the digestive tract, but the most common sites are the stomach, duodenum, and jejunum. Malignant transformation especially in the esophagus is rare. Here, we aim to report an unusual case of mid‐esophageal adenocarcinoma that originated from a heterotopic pancreas.
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Affiliation(s)
- Yong‐Bo Yang
- First Department of Thoracic Surgery Peking University Cancer Hospital and Institute Beijing China
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
| | - Yi‐Qiang Liu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
- Department of Pathology Peking University Cancer Hospital and Institute Beijing China
| | - Liang Dai
- First Department of Thoracic Surgery Peking University Cancer Hospital and Institute Beijing China
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
| | - Wan‐Pu Yan
- First Department of Thoracic Surgery Peking University Cancer Hospital and Institute Beijing China
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
| | - Zhen Liang
- First Department of Thoracic Surgery Peking University Cancer Hospital and Institute Beijing China
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
| | - Ke‐Neng Chen
- First Department of Thoracic Surgery Peking University Cancer Hospital and Institute Beijing China
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education Peking University Cancer Hospital and Institute Beijing China
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35
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Kimura J, Okabayashi T, Sui K, Murokawa T, Tabuchi M, Aida M, Iwata J, Hata Y. Clinicopathological features of intraductal papillary mucinous neoplasm derived from ectopic pancreas: A systematic review. Surg Open Sci 2022; 8:62-68. [PMID: 35392578 PMCID: PMC8980485 DOI: 10.1016/j.sopen.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/08/2022] [Accepted: 03/04/2022] [Indexed: 02/07/2023] Open
Abstract
Background Methods Results Conclusion
The ectopic pancreas can be complicated with pancreatitis, pseudocyst formation, cyst formation, insulinoma, adenoma, and malignant transformation. Intraductal papillary mucinous neoplasm (IPMN) derived from the ectopic pancreas is rare and can undergo malignant transformation. It is challenging to diagnose IPMN derived from ectopic pancreas preoperatively using the existing imaging modalities. Moreover, the clinicopathological characteristics of these tumors have not been elucidated. We performed a review of case reports on IPMNs derived from the ectopic pancreas, including intraductal papillary mucinous carcinoma (IPMC) that was treated in our hospital, to determine the clinicopathological features of the tumors. This is the first systematic review of the literature on IPMN derived from the ectopic pancreas. The review revealed that IPMN derived from the ectopic pancreas was diagnosed incidentally in most patients, and some patients were asymptomatic. The existing imaging modalities may not accurately diagnose the condition preoperatively and differentiate between IPMN and IPMC. Risk factors for malignant transformation should be clarified through further research.
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36
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Ectopic pancreas leading to biliary dilatation: A case report. Clin Res Hepatol Gastroenterol 2022; 46:101787. [PMID: 34384929 DOI: 10.1016/j.clinre.2021.101787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 02/04/2023]
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Mundackal N, Arslan ME, Decker C, Lee H, Nigam A. The removal of ectopic pancreas to prevent carcinoma development. Am J Surg 2021; 222:1196-1197. [PMID: 34256929 DOI: 10.1016/j.amjsurg.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023]
Affiliation(s)
| | | | | | - Hwajeong Lee
- Pathology, Albany Medical Center, Albany, NY, USA
| | - Ankesh Nigam
- Department of Surgery, Albany Medical Center, Albany, NY, USA.
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38
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Wang L, Li L, Fu L, Zheng Y. Ectopic Pancreatitis in the Gastric Antrum Mimicking Malignancy on FDG PET/CT. Clin Nucl Med 2021; 46:664-666. [PMID: 33512951 DOI: 10.1097/rlu.0000000000003519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 34-year-old man suffered intermittent abdominal pain for 1 month, especially after drinking or eating. Enhancement CT was performed to determine the cause, which detected a soft tissue mass in the gastric antrum, suggestive of possible malignancy. FDG PET/CT scan was undertaken for staging, which showed increased metabolism in the known gastric mass, also suggestive of malignancy. However, this lesion was confirmed as ectopic pancreatitis pathologically.
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Affiliation(s)
- Ling Wang
- From the Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, China
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39
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Liu X, Wu X, Tuo B, Wu H. Ectopic pancreas appearing as a giant gastric cyst mimicking gastric lymphangioma: a case report and a brief review. BMC Gastroenterol 2021; 21:151. [PMID: 33823798 PMCID: PMC8022400 DOI: 10.1186/s12876-021-01686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Background Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular communication with the normal body of the pancreas. Despite improvements in diagnostic endoscopy and imaging studies, differentiating ectopic pancreatic tissue from gastric submucosal diseases remains a challenge. Case presentation Here, we present a case of a 44-year-old woman with severe epigastric pain. Initially, gastric lymphangioma was highly suspected due to a well-demarcated protruding mass with a large size that occurred in the submucosal layer of the gastric antrum and appeared as a cystic lesion. The final correct diagnosis of gastric EP was made during surgery. Conclusion Gastric EP with serous oligocystic adenoma appearing as a giant gastric cyst is extremely rare. The difficulty of making an accurate diagnosis and differential diagnosis is highlighted, which may provide additional clinical experience for the diagnosis of EP with serous oligocystic adenoma in the stomach.
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Affiliation(s)
- Xuemei Liu
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou Province, China
| | - Xinglong Wu
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou Province, China
| | - Biguang Tuo
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou Province, China
| | - Huichao Wu
- Department of Gastroenterology, Affiliated Hospital of Zunyi Medical University, Zunyi, 563003, Guizhou Province, China.
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40
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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: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [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.
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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.
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41
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Leung G, Mills J, Bucobo JC, Docimo S. Evaluation and management of a pancreatic rest noted during pre-bariatric surgery screening endoscopy. Surg Endosc 2020; 35:536-561. [PMID: 33006030 DOI: 10.1007/s00464-020-08040-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/22/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Pancreatic rest (PR) is an ectopic pancreatic lesion that is usually found incidentally on endoscopy or surgery. While most lesions do not have clinical significance, some patients are symptomatic and rarely, PR can predispose to malignancy. With the growing popularity of bariatric surgery, it has been unclear how to manage PR found on screening endoscopies, prior to bariatric surgery. Through review of the current literature, we propose an algorithm for clinicians to evaluate and manage PR found on screening endoscopies prior to bariatric surgery. METHODS We performed a literature search in PubMed pertaining to PR, clinical characteristics, risk of malignant transformation, endoscopic characteristics, histological descriptions, and resection techniques. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we found 33 published articles from 2001 to 2019, including case reports, case series, retrospective cohorts, and a review paper. RESULTS PR is commonly found incidentally in the gastric antrum. Larger lesions have a higher risk of being symptomatic or predisposing to malignant transformation. Endoscopic ultrasound (EUS) can assist in the diagnosis of PR and guide resection technique. Certain histological characteristics, such as Heinrich class, grading of neoplasia, and genetic alterations, can determine malignancy risk of PR. Resection technique, either endoscopically or surgically, should be based on lesion size, depth of wall invasion, and the endoscopists' level of skill in endoscopic resection. CONCLUSIONS Proper evaluation and treatment of PR should be considered because of the risk for symptoms and malignant transformation. Symptomatic lesions and those at risk for malignant transformation should be considered for resection. EUS can guide the diagnosis and type of resection, either endoscopically through EMR or ESD or surgically through sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB).
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Affiliation(s)
- Galen Leung
- Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - John Mills
- Department of Surgery, University of Pittsburgh Medical Center Pinnacle, 4300 Londonderry Road, Harrisburg, PA, 17109, USA
| | - Juan Carlos Bucobo
- Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
| | - Salvatore Docimo
- Department of Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA
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Submucosal Tunneling Endoscopic Resection for the Management of Heterotopic Pancreas With Cystic Degeneration. ACG Case Rep J 2020; 7:e00419. [PMID: 32766361 PMCID: PMC7357709 DOI: 10.14309/crj.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
Heterotopic pancreas is pancreatic tissue present outside of the normal location of the pancreas. In the presence of cystic degeneration, heterotopic pancreas is clinically significant because of the symptoms it causes and its physical resemblance to cancerous growth. A diagnosis of heterotopic pancreas is achieved with the aid of various endoscopic techniques for tissue removal. Submucosal tunneling endoscopic resection has proven successful for the resection of gastric subepithelial masses. We present a 53-year-old woman undergoing submucosal tunneling endoscopic resection for the resection of a subepithelial gastric cyst caused by heterotopic pancreas with cystic degeneration.
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Gallo G, Mangogna A, Manco G, Caramaschi S, Salviato T. Pancreatic ductal adenocarcinoma in colonic wall: metastatic disease or cancerized pancreatic ectopic tissue? Surg Case Rep 2020; 6:80. [PMID: 32323034 PMCID: PMC7176754 DOI: 10.1186/s40792-020-00846-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
We describe two unusual cases of cancerized ectopic pancreatic parenchyma within the wall of the left colon. Although the morphology of the neoplastic cells and their immunoprofile were consistent with pancreatic ductal adenocarcinoma, the detection of small foci of regular ectopic pancreatic tissue close to dysplastic glands at the periphery of the cancerized mass represented the key diagnostic features. A careful histological examination of surgical samples represents the correct approach to the diagnosis of this rare disease, mostly when total-body CT scan evaluation confirms the lack of bilio-pancreatic masses.
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Affiliation(s)
- Graziana Gallo
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Mangogna
- Department of Medical, Surgical and Health Science, University of Trieste, Cattinara Hospital, Strada di Fiume, 447, 34149, Trieste, Italy.
| | | | - Stefania Caramaschi
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Tiziana Salviato
- Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Rodríguez-Seguel E, Villamayor L, Arroyo N, De Andrés MP, Real FX, Martín F, Cano DA, Rojas A. Loss of GATA4 causes ectopic pancreas in the stomach. J Pathol 2020; 250:362-373. [PMID: 31875961 DOI: 10.1002/path.5378] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/13/2022]
Abstract
Pancreatic heterotopia is defined as pancreatic tissue outside its normal location in the body and anatomically separated from the pancreas. In this work we have analyzed the stomach glandular epithelium of Gata4 flox/flox ; Pdx1-Cre mice (Gata4KO mice). We found that Gata4KO glandular epithelium displays an atypical morphology similar to the cornified squamous epithelium and exhibits upregulation of forestomach markers. The developing gastric units fail to form properly, and the glandular epithelial cells do not express markers of gastric gland in the absence of GATA4. Of interest, the developing glands of the Gata4KO stomach express pancreatic cell markers. Furthermore, a mass of pancreatic tissue located in the subserosa of the Gata4KO stomach is observed at adult stages. Heterotopic pancreas found in Gata4-deficient mice contains all three pancreatic cell lineages: ductal, acinar, and endocrine. Moreover, Gata4 expression is downregulated in ectopic pancreatic tissue of some human biopsy samples. © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Elisa Rodríguez-Seguel
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain
| | - Laura Villamayor
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain
| | - Noelia Arroyo
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain
| | | | - Francisco X Real
- Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, Spain
- CIBERONC, Madrid, Spain
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Franz Martín
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - David A Cano
- Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
| | - Anabel Rojas
- Centro Andaluz de Biología Molecular y Medicina Regenerativa-CABIMER, Universidad Pablo de Olavide, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas (CSIC), Seville, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
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