heterotopic pancreas in the gastrointestinal tract is primarily lined

Posted on 02 Июн 20188

Pancreatic and gastric heterotopia with associated submucosal

Pancreatic and gastric heterotopia with associated submucosal
- The reported incidence of heterotopic pancreas or gastric tissue in the general . Mass-like lesions in the gastrointestinal tract, causing clinical symptoms due to . 5 cm in length, with mostly smooth mucosal lining (fig.

Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40). Gastric heterotopia, Pancreatic heterotopia, Double balloon enteroscopy, Intermittent bowel obstruction Pancreatic and gastric heterotopias are defined as pancreatic and gastric tissues outside their typical location without vascular or anatomical continuity with the pancreas proper or the stomach [ ]. Thus, a clinicoradiologic correlation and a high index of suspicion are needed in cases having a solid portion or even in an asymptomatic patient and histologic confirmation through surgical resection are required to detect malignant transformation in the gastric heterotopic pancreas as in the present case. Therefore, a gastric heterotopic pancreas with clinical symptoms or a lesion larger than 3 cm in size regardless of the symptoms should be treated with surgical resection with histologic diagnosis. A dysplastic change was found in the epithelium of the cystic portion of the heterotopic pancreas, adjacent to the invasive adenocarcinoma ( ).

However, the clinical symptoms such as weight loss, nausea, and vomiting should raise a suspicion of malignant transformation, which may occur even without any clinical symptoms as in the present case. It can be found anywhere in the gastrointestinal tract and the predilection site is the stomach, mostly in the antrum and prepyloric region on the greater curvature or posterior wall. On esophagogastroduodenoscopy (EGD), a submucosal mass with an irregular central umbilication was found in the gastric antrum ( ). The heterotopic pancreas is defined as a pancreatic tissue found outside the eutopic pancreas without anatomic or vascular connections between them. For asymptomatic small lesions less than 2 cm in size, only local resection can be considered, although histologic confirmation is required at the operation field by frozen section to decide the extent of surgery.

Heinrich classified the heterotopic pancreas into 3 types ( ): type I, all the components of the pancreas including ducts, acini, and endocrine islets; type II, ducts with acini; and type III, ducts with a few acini or dilated ducts only, so called adenomyoma. The abdominal CT reveals a well-demarcated multiseptate cystic mass (arrows) in the gastric antrum. A wedge resection was performed under the clinical impression of gastrointestinal stromal tumor. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Adenocarcinoma arising in gastric heterotopic pancreas: clinicopathological and immunohistochemical study with genetic analysis of a case. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. When the pancreaticobiliary-type ducts predominate, they are often surrounded by hypertrophic smooth muscle bundles. Kaneda M, Yano T, Yamamoto T, Suzuki T, Fujimori K, Itoh H, Mizumoto R. Firstly, the carcinoma must be found within or close to the heterotopic pancreas. Combined gastric and pancreatic heterotopias, although unusual, have been described in the duodenum and jejunum, and in other structures, including Meckel's diverticulum and the ampulla of Vater.

Adenocarcinoma arising in gastric heterotopic pancreas a case
A heterotopic pancreas in the gastrointestinal tract is mostly found incidentally . Microscopically, the cystic portion was lined by a single layer of flat, cuboidal .

The term aberrant pancreas is used to describe ectopic pancreatic tissue lying outside its . Of the antrum), duodenum, small intestine, or anywhere in the GI tract. Of aberrant pancreas are heterogeneous lesions, mainly hypoechoic or intermediate . Local suture line; massive local lymphoid hyperplasia; ectopic pancreas; .

In the solid area, the adenocarcinoma components forming well-formed tubules ( ) infiltrated the underlying proper muscle layer and the overlying mucosa of the stomach. We believe this is the first report of all three histological entities co-existing in an obstructive ileal lesion in an adult. We describe the second case of adenocarcinoma arising in a gastric heterotopic pancreas of an asymptomatic 35-yr-old man in Korea. The clinical course of adenocarcinomas arising in a gastric heterotopic pancreas has not been well documented because of the small number of reported cases, however, the same treatment modality as that for a primary gastric carcinoma is being considered ( The early diagnosis of malignant transformation in the gastric heterotopic pancreas may be difficult by endoscopic biopsy because of the intramural location of the mass and the delayed involvement of the overlying mucosa. In addition, the identical CK7+/CK20- phenotype in both tumor cells and non-neoplastic ductal epithelium in the heterotopic pancreas corresponds to the result of the study by Duval et al.

The heterotopic pancreas is usually small, measuring 3 cm or less in diameter, however, the gastric lesions tend to be larger than those in other sites. The present case belongs to the Heinrich type III (adenomyoma) showing predominant dilated pancreaticobiliary-type ducts with periductal glandular structures and surrounding smooth muscle bundles. On esophagogastroduodenoscopy (EGD), a submucosal mass with an irregular central umbilication was found in the gastric antrum ( ). Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. On computed tomography, a 7-cm luminal polypoid mass extending into the distal ileum was discovered.

We report a novel case of pancreatic and gastric heterotopia with an associated submucosal lipoma in a 38-year-old female with a recent history of rectal cancer and chronic crampy abdominal pain. Thus, a clinicoradiologic correlation and a high index of suspicion are needed in cases having a solid portion or even in an asymptomatic patient and histologic confirmation through surgical resection are required to detect malignant transformation in the gastric heterotopic pancreas as in the present case. The heterotopic (ectopic) pancreas may contain any mixture of tissues normally found in the pancreas. H&E stain, ×200) and focal periductal glandular structures without islet cell islands ( The solid area shows well to moderately differentiated adenocarcinoma with an adjacent dysplastic change in the lining cells of the dilated ductal structures (H&E stain, ×40). The overlying gastric mucosa showed CK7+ only in mucous neck cells and CK20+ in foveolar epithelial cells. Positive immunoreactivity for cytokeratin 7 is observed in the tumor cells and ductal epithelium in the heterotopic pancreas (×40). A case of submucosal cyst of the stomach originating in the heterotopic pancreas. Therefore, a gastric heterotopic pancreas with clinical symptoms or a lesion larger than 3 cm in size regardless of the symptoms should be treated with surgical resection with histologic diagnosis. Thirdly, the non-neoplastic heterotopic pancreatic tissue must comprise at least fully developed acini or ductal structures. Heinrich classified the heterotopic pancreas into 3 types ( ): type I, all the components of the pancreas including ducts, acini, and endocrine islets; type II, ducts with acini; and type III, ducts with a few acini or dilated ducts only, so called adenomyoma.

Pancreatic and gastric heterotopy in the gastrointestinal tract

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