Abstract
BackgroundPancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation.MethodsA prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).ResultsA total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%.ConclusionsPH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.
Highlights
Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system
Malignant transformation originating from PH is extremely rare, it has been reported in several cases in the literature [12, 13]
Because of the scarcity of symptomatic PH cases in the literature [6, 14,15,16], we investigated our series of duodenal PH with a special focus on its clinical relevance and impact
Summary
Pancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Pancreatic heterotopia (PH) was first reported by Jean-Schultz in 1729 and is defined as pancreatic tissue without anatomical or vascular connection to the pancreas [1, 2]. The ectopic pancreatic tissue possesses its own duct system and vascular supply [3, 4]. It is mostly found in Betzler et al BMC Surgery (2017) 17:53. Because of the scarcity of symptomatic PH cases in the literature [6, 14,15,16], we investigated our series of duodenal PH with a special focus on its clinical relevance and impact
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