A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid FDG uptake mimicking a malignant pancreatic tumor: a systematic case review

Hiroaki Nagano,Toyokuni Suenaga,Masaki Kitazono,Atsushi Tani,Sadao Tanaka,Toru Niihara,Mari Toyota,Masayuki Nakajo,Yoriko Kajiya,Yoshihiko Fukukura,Takashi Yoshiura

doi:10.1186/s12876-017-0704-8

Hiroaki Nagano, Toyokuni Suenaga + Show 9 more

Open Access

https://doi.org/10.1186/s12876-017-0704-8

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Abstract

BackgroundPancreatic hamartomas are extremely rare and may be misdiagnosed as malignant tumors. We report herein a case of a small, solid-type pancreatic hamartoma.Case presentationA 72-year-old female was incidentally detected pancreatic lesion by ultrasonography. Computed tomography and magnetic resonance imaging revealed a 2.0-cm solid lesion. The main pancreatic duct (MPD) was obstructed by the lesion in the head of the pancreas, and the upstream MPD was dilated. 18F-fluorodeoxyglucose (FDG) accumulated avidly in the lesion and increased in FDG intensity from the early to the delayed images. The histopathological studies confirmed the diagnosis of pancreatic hamartoma. Immunohistochemically, the cell membrane of the accessory glands and ducts showed homogeneous expression of glucose transporter type I and hexokinase II.ConclusionPancreatic hamartomas causing dilatation of the MPD are extremely rare, and this appears to be the first case of a hamartoma to take up FDG avidly. It was a rare occurrence and should be noted that pancreatic hamartomas can cause an obstruction of the MPD and show avid FDG uptake, thereby mimicking malignant pancreatic tumors.

Highlights

Pancreatic hamartomas are extremely rare and may be misdiagnosed as malignant tumors
Pancreatic hamartomas causing dilatation of the main pancreatic duct (MPD) are extremely rare, and this appears to be the first case of a hamartoma to take up FDG avidly
It was a rare occurrence and should be noted that pancreatic hamartomas can cause an obstruction of the MPD and show avid FDG uptake, thereby mimicking malignant pancreatic tumors

Summary

Conclusion

Pancreatic hamartomas causing dilatation of the MPD were extremely rare, and showed no avid FDG uptake in the previously reported cases. We described a rare case of a small, solid-type pancreatic hamartoma that showed an obstruction of the main pancreatic duct and avid FDG uptake. Radiologists should be aware that pancreatic hamartomas may be associated with these findings. Fluorodeoxyglucose; GLUT-1: Glucose transporter type I; HE: Hematoxylineosin staining; HK-II: Hexokinase II; MPD: Main pancreatic duct; MRCP: MR cholangiopancreatography; MRI: Magnetic resonance imaging; PET/ CT: Positron emission tomography/CT; SUVmax: Maximum standardized uptake value

Background

Discussion