Heterotopia pancreática: análise clínico-patológica de 18 doentes

Sansom Henrique Bromberg,Antonio Fernando Allemand Borges,Nagamassa Yamaguchi,Maria Isete Fares Franco,Carlos Camilo Neto,Luis Celso Mattosinho França

doi:10.1590/s0100-69912010000600007

Sansom Henrique Bromberg, Antonio Fernando Allemand Borges + Show 4 more

Open Access

https://doi.org/10.1590/s0100-69912010000600007

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Abstract

To analyze the clinical and pathological features of heterotopic pancreatic tissue in abdominal digestive organs. We retrospectively studied 18 patients with histologically diagnosed heterotopic pancreas. Clinical and histopathologic data were reviewed. Heterotopic pancreatic tissues were classified in three histological models: Type I consists of three components of normal pancreas (acini, ducts and islets), type II with two components and type three with only one component. The mean age was 52.7 years, ranging from 34 to 73 years, nine of them men and nine women. Symptoms were observed in only four patients, and their lesions were diagnosed by gastroscopy. The remaining 14 were asymptomatic and their anomalies were discovered accidentally. Most of the lesions were located in the upper gastrointestinal tract: seven (38.9%) in the stomach, six (33.3%) in the duodenum and three (16.6%) in the jejunum. Heterotopia was mostly located in the submucosa (83.3%) but was also observed in the muscularis propria and in the sub-serosa. In seven specimens (38.9%) all pancreatic components were found (type I), in eight (44.4%) exocrine glands and excretory ducts were present (type II) and in three (16.7%) only exocrine tissue was observed (type III). Pancreatic heterotopia is rare. Patients with pancreatic ectopia diagnosed by pathological study, whether asymptomatic or with mild symptoms, should be observed. Lesions incidentally detected during surgeries need to be removed by conservative procedures.

Highlights

Heterotopic, aberrant or ectopic pancreas is defined as the presence of pancreatic tissue in topographic anomaly, with no anatomical, neural or vascular connection to the normal pancreas[1].The heterotopic pancreas (HP) is a relatively uncommon congenital anomaly, with an incidence between 0.55% and 13.7% in autopsy series and mean frequency between 1 and 2%1,2
Most patients with ectopic pancreas are asymptomatic and diagnosis is usually performed during radiological examination or endoscopy of the digestive tract or during surgical explorations motivated by other diseases
This study aimed to review all patients in whom the histological diagnosis of ectopic pancreas was performed at our institution, analyzing clinical and pathological parameters of this anomaly

Summary

Introduction

The heterotopic pancreas (HP) is a relatively uncommon congenital anomaly, with an incidence between 0.55% and 13.7% in autopsy series and mean frequency between 1 and 2%1,2. One ectopic pancreas in found every 500 surgical procedures in the upper abdomen[1]. In adults it occurs preferentially in males between the fourth and sixth decades of life. It is found mainly in the stomach, duodenum and jejunum, in much smaller proportions in the ileum and Meckel’s diverticulum, and it is rarely found in the esophagus, liver, gallbladder, omentum, lungs, mediastinum, fallopian tubes and umbilicus[3,4].

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