Diagnosis Of Ectopic Pancreas Research Articles

Heterotopic pancreas in the jejunum: A case report and literature review

Ectopic pancreas is the presence of the pancreatic tissue outside its typical location; it is an uncommon developmental anomaly. It may occur at different sites in the gastrointestinal tract with the stomach being the most common site. Usually, it is a silent anomaly, but it may become symptomatic when complicated by inflammation, bleeding, obstruction, or malignant transformation. In this report, a 42-year-old male case of refractory immune thrombocytopenia was admitted for elective open splenectomy. During the operation, an incidental rounded mass lesion arising from the jejunum was resected, and the diagnosis of ectopic pancreas was made after the histopathology result. Despite being a rare condition, ectopic pancreas should remain in the differential diagnosis of any jejunal mass lesion.

A stubborn anemia caused by ectopic pancreas bleeding in the jejunum revealed by capsule endoscopy.

Ectopic pancreas is extremely rare in clinical setting. Meanwhile, a stubborn anemia without obvious dark bloody stool due to ectopic pancreas diagnosed by capsule endoscopy has not been reported. We reported a case of an ectopic pancreas inducing obscure gastrointestinal bleeding in a 70-year-old woman presenting as stubborn anemia, which was diagnosed by capsule endoscopy. The patient recovered well after resection the lesion. Diagnosis of ectopic pancreas is extremely difficult with conventional techniques. Endoscopists should pay more attention to the ectopic pancreas as a rare differential consideration for occult intestinal bleeding.

Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration.

To study the clinical, endoscopic, sonographic, and cytologic features of ectopic pancreas (EP). This was a retrospective study performed at an academic referral center including two hospitals. Institutional review board approval was obtained. Patients referred to the University Hospital or Denver Health Medical Center Gastrointestinal Endoscopy Lab for gastroduodenal subepithelial lesions (SEL) with a final diagnosis of EP between January 2009 and December 2013 were identified. Patients in this group were selected for the study if they underwent endoscopic ultrasound (EUS) with fine-needle aspiration (FNA) or deep biopsy. A review of the medical record was performed specifically to review the following information: presenting symptoms, endoscopic and EUS findings, computed tomography or magnetic resonance imaging findings, pathology results, procedure-related adverse events, and subsequent treatments after EUS-FNA. EUS with FNA or deep submucosal biopsy was performed in all patients on an outpatient basais by one of two physicians (Attwell A, Fukami N). Review of all subsequent clinic notes and operative reports was performed in order to determine follow-up and final diagnoses. Between July 2009 and December 2013, 10 patients [3 males, 7 females, median age 52 (26-64) years] underwent EUS for a gastroduodenal SEL and were diagnosed with EP. One patient was symptomatic. Six (60%) lesions were in the antrum, 3 (30%) in the body, and 1 (10%) in the duodenum. A mucosal dimple was noted in 6 (60%). Mean lesion size was 17 (8-25) mm. Gastrointestinal wall involvement: muscularis mucosae, 10%; submucosa, 70%; muscularis propria, 60%; and serosa, 10%. Nine (90%) lesions were hypoechoic and 5 (50%) were homogenous. A duct was seen in 5 (50%). FNA was attempted in 9 (90%) and successful in 8 (80%) patients after 4 (2-6) passes. Cytology showed acini or ducts in 7 of 8 (88%). Superficial biopsies in 7 patients (70%) showed normal gastric mucosa. Deep endoscopic biopsies were taken in 2 patients and diagnostic in one. One patient (10%) developed pancreatitis after EUS-FNA. Two patients (20%) underwent surgery to relieve symptoms or confirm the diagnosis. The main limitation of the study was the fact that it was retrospective and performed at a single medical center. EUS features of EP include antral location, mucosal dimple, location in layers 3-4, and lesional duct, and FNA or biopsy is accurate and effective.

Endoscopic ultrasonography for ectopic pancreas in upper gastrointestinal tract

Objective To evaluate endoscopic ultrasonography （EUS） for diagnosis and treatment of ectopic pancreas in upper gastrointestinal tract. Methods Data of 52 patients with ectopic pancreas diagnosed by EUS and confirmed by pathological examination were reviewed. The feature of EUS image and diagnostic accuracy were retrospectively analyzed. Results Out of 52 patients, 41 （78.85%） were pathologically diagnosed as having eetopic pancreas, 6 were stromal tumors, 4 were leiomyoma and 1 was nerve sheath tumor. All eetopic pancreases presented as protruding lesions, in which 37 were located at gastric antrum, 2 in duodenum, 1 in gastric body and 1 in gastric fundus. Under EUS, 1 case appeared as hyperechoic, 10 as isoechoic, 18 as hypoechoic and 12 as mixed echoic. The lesion involved mucosa in 2 cases, muscularis mueosae in 8, submucosa in 30 and museularis propria in 1, in which 15 cases from submucosa underwent endoscopic resection. Bleeding occurred in 2 cases and no other complications occurred. There was one relapse during the 6 months of followed-up. Conclusion EUS is valuable and safe for the diagnosis of ectopic pancreas in upper gastrointestinal tract. Depth of lesions revealed by EUS can help further treatment. Key words: Endoscopic uhrasonography ; Pancreatic diseases ; Ectopic ; Therapy

Ectopic pancreatic tissue in the cecum

Sir, A 58 years male was admitted to our hospital because of persistent right lower quadrant abdominal pain and melena. He had no history of a similar type of abdominal pain or melena. All blood investigations were normal. Skiagram and USG abdomen were also normal. Stool occult blood was positive. Colonoscopy revealed thickening and inflammation with ulceration in the cecum, no evidence of sub-mucosal nodule with central umbilication was seen [Figure 1]. HPE examination showed pancreatic acini and duct system. Each acinus is made up of irregular clusters of secreting cells. Intercalated ducts are lined by simple low cuboidal epithelium [Figure 2]. After initial medical management, the patient was symptom free. The patient refused surgery. To our knowledge, this is the first case of ectopic pancreatic tissue in the cecum. Figure 1 Ulcer in the cecum Figure 2 Pancreatic acini and duct system (Hematoxylin and eosin stain, ×100) Ectopic pancreatic tissue is common and functional. The frequency in autopsy has been reported from 0.55 to 13.7%.[1] The most common sites are the wall of the stomach, duodenum, followed by jejunum, Meckels, and ileum.[2] Most patients with ectopic pancreas are asymptomatic and are diagnosed at endoscopy, operation or autopsy, and, if present, symptoms are non-specific and depend on the location and complications of heterotopic tissue.[3] Typically, heterotopic pancreatic tissue is a sub-mucosal nodule with central umbilication. The diagnosis of ectopic pancreas could be made either by endoscopy or radiological investigation. The definitive diagnosis is made by histopathologic examination. Histopathologic examination reveals normal-appearing pancreatic acinar cells, glands, and sometimes islets of Langerhans. Ectopic pancreatic tissue may cause pain, mucosal bleeding and may sometimes be a lead point for intussusception. Treatment of symptomatic ectopic pancreatic tissue is surgical excision.

Changing Pattern of Ectopic Pancreas: 22 Years of Experience in a Medical Center

Ectopic pancreas is usually a silent gastrointestinal malformation. It may become clinically evident when complicated by chronic inflammation or by growth. More ileal ectopic pancreas has been found in recent years in our hospital. We report the clinical manifestation of ectopic pancreas over the past 22 years. We reviewed the medical records of patients seen between May 1984 and December 2005 at Mackay Memorial Hospital, with a diagnosis of ectopic pancreas, and extracted clinical and histopathology data from the records. A total of 39 patients (18 male, 21 female; mean age, 46 years) were diagnosed with ectopic pancreas. Most patients were aged between 30 and 50 years. Only 15 (38%) had symptoms suggestive of ectopic pancreas. These included abdominal pain (n = 9), upper gastrointestinal bleeding (n = 5), and abdominal distension (n = 2). The diagnosis in the other 24 patients was made incidentally, usually during surgery for other conditions. While lesions in the stomach were more likely to be diagnosed because of symptoms (12 of 13), lesions in the small bowel were almost always diagnosed incidentally. Only one of eight in the duodenum, one of 10 in the jejunum, and one of eight in the ileum, were isolated findings. One case of ectopic pancreas was detected by capsule endoscopy. Ectopic pancreas can be found in various parts of the gastrointestinal tract. The high proportion of ileal ectopic pancreas is unexpected and needs further study.

Ectopic pancreas: usual and unusual features.

Nine patients with ectopic pancreas in the stomach (8 patients) and duodenum (1 patient) were studied both radiographically and endoscopically. Correct diagnosis was made by radiography in six cases and by endoscopy in seven cases. Masses radiographically larger than 3 cm in diameter were seen in three patients. The incorrect radiographic diagnoses were related to the presence of a large mass in one patient and to the complications of severe bleeding and gastric outlet obstruction in the other two. Endoscopy and radiography are complementary modalities in the diagnosis of ectopic pancreas.