Heterotopic Pancreatic Tissue Research Articles

1761 Heterotopic Pancreatic, Sebaceous, and Gastric Tissue: Report of Case and Review of the Literature

INTRODUCTION: Heterotopic mucosa refers to the presence of normal tissue at a foreign site, and is thought to be either congenital from an error during organogenesis or metaplastic from an error during differentiation of pluripotent cells. We present a rare case of pancreatic and sebaceous gland heterotopia in the esophagus and gastric mucosal heterotopia in the rectum. To our knowledge, this is the first case with three types of heterotopia found in a single patient. CASE DESCRIPTION/METHODS: A 61-year-old man with GERD presented with periodic dysphagia to solids. He denied regurgitation, heartburn, melena, hematochezia, constipation, and diarrhea. Physical exam was unremarkable. Barium swallow showed a small hiatal hernia, and mild concentric narrowing at the GE junction. EGD showed a low grade Schatzki ring and diffuse beige 2-3 mm specks in middle third of esophagus. A colonoscopy was also scheduled for screening purposes and showed a 20 mm semi-sessile polyp in the rectum. Biopsies identified focal pancreatic and sebaceous gland heterotopia in the esophagus and gastric fundus heterotopia in the rectum. DISCUSSION: Heterotopic pancreatic, sebaceous, and gastric mucosa have been described along the entire GI tract. Our literature review identified 11 case reports of pancreatic heterotopia in the esophagus, 23 case reports of heterotopic sebaceous glands in the esophagus, and 73 case reports of gastric heterotopia in the rectum. However, no case reports found a single patient with all three types of heterotopia. In all three types, there was a male predominance, and ages ranged from birth to 6th decade of life. The origin of the heterotopic tissues is hypothesized to be either congenital vs metaplastic. As the combination of organ heterotopia described here includes components of mesoderm and endoderm, there was presumably incomplete cellular differentiation in weeks 2-3 of embryonic development. Patients can be asymptomatic or present with dysphagia, epigastric pain, or reflux with heterotopic pancreatic mucosa and sebaceous glands in the esophagus, and hematochezia with heterotopic gastric mucosa in the rectum. Treatment for the heterotopic tissues vary but surgical or endoscopic resection is typically pursued. Given that the tissue is often removed, it is unclear the malignant potential of the lesions and close follow up is necessary. Ultimately, presentations such as hematochezia and dysphagia may have rare etiologies and necessitates sufficient biopsies.

1306 Endoscopic Mucosal Resection of Pancreatic Rest Presenting as a Submucosal Nodule in the Gastric Antrum

INTRODUCTION: Pancreatic rest (PR) is defined as ectopic pancreatic tissue outside the normal pancreatic parenchyma, with a vascular and nerve supply separate from the pancreas itself and has a prevalence of 0.55-14%. It is believed to arise during rotation of the foregut, when fragments of the pancreas become separated from the main body and are deposited at ectopic sites. CASE DESCRIPTION/METHODS: An 82-year-old male with a history of GERD presented with episodes of epigastric abdominal pain of 2 month duration that did not improve despite PPI therapy. He denied any other symptoms such as bleeding, weight loss or change in bowel habits. Physical examination revealed a non-distended abdomen and mid-epigastric tenderness. An EGD performed for evaluation of GERD 3 years prior found an antral nodule. A repeat EGD was done this time for evaluation of the epigastric pain and showed a mobile submucosal nodule in the antrum measuring 7-8 mm, unchanged from before. EUS was performed for further evaluation and showed a hypoechoic gastric submucosal lesion, arising from the muscularis mucosa, 8 mm in size. No high-risk features were present. The area was resected using EMR and the defect was closed with clips. The EUS also showed a cystic dilation of the pancreatic duct in the pancreatic head measuring 5 mm, suspicious for main duct IPMN. Results from the EMR biopsy demonstrated heterotopic pancreatic tissue with focal low grade pancreatic intraepithelial neoplasia (PanIN), with clear margins and reactive gastropathy with focal intestinal metaplasia. There was resolution of the abdominal pain after the procedure. A repeat EGD/EUS will be done in 1 year. MRI will be performed in 6 months for surveillance of the pancreatic duct dilation. DISCUSSION: PR can be found virtually anywhere along the GI tract, but they are typically found in the stomach along the greater curvature and antrum. Although usually asymptomatic, the most reported symptom is mid abdominal pain. Complications of gastric ectopic pancreas include acute or chronic pancreatitis, necrosis, pseudocyst, gastric outlet obstruction and rarely carcinoma. PanIN is neoplastic epithelial proliferation that occurs in the small caliber pancreatic ducts; it is divided in 3 degrees based on architectural and nuclear atypia and has potential progression to invasive ductal adenocarcinoma. In our case, PanIN 1 was found on histology and the lesion was completely resected. PR should always be considered when evaluating a submucosal lesion of the GI tract.

Gastric outlet obstruction due to gastric duplication cysts with heterotopic pancreatic tissue treated by marsupialization

Abstract Gastric duplication cysts are rare congenital anomalies often treated with complete surgical excision, but this is not always possible. In such cases, resection and reconstruction have been advocated, but this may lead to significant morbidity. We present a unique case of a 3-year old girl who presented with complete gastric outlet obstruction due to multiple gastric duplication cysts with heterotopic pancreatic tissue treated with marsupialization and endoscopic surveillance as an alternative to gastric resection and reconstruction. This approach avoids morbidities from a more extensive procedure and in this case, alleviated the obstruction, averted sequelae secondary to heterotopic pancreatic tissue, and provides surveillance in the rare case of malignant degeneration. The child tolerated the procedure well and has been symptom free for the past year.

Intraductal papillary mucinous neoplasm developed on an ectopic gastric pancreas

In January 2014, a 69-year-old man with end-stage renal disease requiring dialysis was evaluated for kidney transplantation. During the work-up, abdominal ultrasound found an ill-defined intraabdominal cystic lesion. Abdominal magnetic resonance imaging revealed a 60 × 50 mm multiloculated cystic lesion developed over the lesser gastric curvature (Fig. 1). An endoscopic ultrasound (EUS) confirmed a subepithelial 60-mm a cystic gastric tumour. Fine needle aspiration was negative for malignancy. In order to rule out a primary gastric tumor, surgery was scheduled. A partial gastrectomy was performed with an uneventful postoperative course. Gross pathology found a 60-mm cystic tumor located into the gastric wall. Histology found heterotopic pancreatic tissue composed by ducts and acini (Fig. 2) into the gastric wall. Epithelial cells were mucin-secreting and columnar with extensive intestinal metaplasia and low degrees of atypia. Mucinous deposits were present over the lesser omentum. The diagnosis of intraductal papillary mucinous neoplasm (IPMN) with low grade dysplasia developed on heterotopic gastric pancreatic tissue was established. Six years later the patient was doing well under dialysis. The prevalence of heterotopic pancreatic tissues ranges from 0, 6 to15% and IPMN development has been rarely reported as a possible complication of a heterotopic pancreas [ [1] Patel N. Berzin T. Intraductal papillary mucinous neoplasm arising in a heterotopic pancreas: a case report. Am J Gastroenterol. 2010; 105: 2513-2514https://doi.org/10.1038/ajg.2010.298 Crossref Scopus (11) Google Scholar ]. Symptoms are unspecific and surgery should be advised based on the size and morphology of the lesion. Fig. 2Histological examination showing heterotopic pancreatic tissue into the gastric wall with acini and ducts. View Large Image Figure Viewer Download Hi-res image

Extraluminal heterotopic pancreatic tissue: An unusual finding

Heterotopic pancreas is defined as pancreatic tissue outside usual anatomic location of the pancreas. The most common location is in the submucosa of the proximal part of the gastrointestinal tract, namely stomach, duodenum, and jejunum. Less commonly, other locations have been reported like the mesentery. It usually presents as an incidental finding during the investigation or operation for acute abdomen. We here present a case of unusual heterotopic extraluminal pancreatic tissue found as scattered multiple tiny spots on the surface of the distal small bowel and its mesentery detected during a laparoscopic appendectomy. A finding that we believe has not been reported before.

Schwannoma, IVC Leiomyosarcoma, and IPMN of heterotopic pancreatic tissue.

Schwannoma, IVC Leiomyosarcoma, and IPMN of heterotopic pancreatic tissue.

Schwannoma, IVC Leiomyosarcoma, and IPMN of heterotopic pancreatic tissue.

Schwannoma, IVC Leiomyosarcoma, and IPMN of heterotopic pancreatic tissue.

Heterotopic Pancreas in Distal Yeyunum as a Cause of Hematoquexia

Introduction: Heterotopic pancreas is defined as pancreatic tissue found outside the usual anatomical location of the pancreas. It is often an incidental finding and can be found at different sites in the gastrointestinal tract. It may become clinically evident when complicated by pathological changes such as inflammation, bleeding, obstruction, and malignant transformation. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of hematochezia and melena. Method: Case report of a 64-year old women with 5 episodes of hematochezia over a period of 18 months. Clinic pathological correlation, evolution and resolution. Result: Patient underwent initial upper endoscopy on his first episode and panendoscopy and colonoscopy on the subsequent episodes with no findings of hemorrhage. She had 1-2.5 gramS decrease in every event. After the last episode she underwent capsule endoscopy where it was detected a 1.5cm polyp at distal yeyunum. Laparoscopic enterectomy was done with no new episode of hematochezia at 1 year. Conclusion: Heterotopic pancreas should be considered as a diferential diagnosis in hematochezia and melena. Jean-Schultz was the first to report that heterotopic pancreas is pancreatic tissue found outside the usual anatomical location of the pancreas. It is a congenital abnormality. The incidence rate is 0.11%-0.21% at autopsy, with a male to female ratio of 3:1. Heterotopic pancreas can exist at any position in the abdominal cavity. It is usually found in the upper gastrointestinal tract, with > 90% of the cases involving the stomach, duodenum or jejunum. Heterotopic pancreas is usually buried in the submucosa. The diameter of heterotopic pancreatic tissue is generally about 1-2 cm

Primary Hepatic Mixed Acinar-Neuroendocrine Tumor: A Rare Case of a Liver Mass

Extra-pancreatic primary acinar cell carcinomas (ACC) are rare and have been reported in the stomach, jejunum, colon and liver. Of the seven hepatic cases reported, most presented with abdominal pain, a liver mass and no pancreatic involvement. This case is one among the unusual cases reported. A 67-year-old lady with past history of chronic hepatitis B infection presented with progressively worsening abdominal pain. Lab workup revealed an elevated lipase (3532 U/L), a normal liver function test, AFP and CA19-9. Abdominal ultrasound and CT showed an 11cm by 8cm heterogeneously enhancing mass in the right hepatic lobe with central enhancement [Figure 1] and no involvement of the pancreas or the biliary tree. Histopathology of the mass revealed atypical proliferation of neoplastic cells with pseudo-glandular formation and occasional prominent nucleoli [Figure 2a]. The cells stained positive for pancytokeratin, CK7, chromogranin, synaptophysin [Figure 2b] and trypsin; and negative for Hep-Par 1 [Figure 3], monoclonal CEA and CA19-9. The histologic features and immunophenotype were consistent with mixed acinar-neuroendocrine tumor. Surveillance MRI and endoscopic ultrasound (EUS) did not demonstrate a pancreatic mass leading to a diagnosis of primary hepatic ACC. It was determined that the tumor was not surgically resectable due to vascular proximity and the patient was referred to an oncologist for systemic chemotherapy. Patients with rare primary hepatic ACC usually present with abdominal pain with normal to low elevations of AFP and CA19-9. A para-neoplastic syndrome causing lipase hyper-secretion as seen in this patient has been mentioned in the literature. CT scan usually shows a single large hypo-enhancing lesion with areas of necrosis or multiple smaller solid lesions. Histopathology reveals typical tumor cells with immmuno-histochemistry demonstrating positivity for trypsin and chymotrypsin for acinar differentiation; synaptophysin for neuroendocrine differentiation. Multiple theories including presence of common progenitor cells showing aberrant pancreatic differentiation or occurrence of heterotopic or metaplastic pancreatic tissue among liver tissue has been implicated in the etio-pathogenesis. This case highlights the occurrence of a rare tumor and that it should be considered in the differential when a vascular tumor is detected in an otherwise healthy liver with normal tumor markers.2320_A Figure 1. shows axial and sagittal sections of Abdominal CT scan demonstrating the extent of the tumor2320_B Figure 2. (a) shows pseudo-glandular formation and prominent nucleoli on H and E stain and Figure 2 (b) shows tumor cells staining positive for synaptophysin2320_C Figure 3. Figure 3 shows islands of normal hepatic tissue with negative staining for Hep-Par 1

Heterotopic subserosal pancreatic tissue in jejunum

Heterotopic pancreas (HP) is typically an asymptomatic malformation that can present anywhere along the gastrointestinal tract. It is frequently detected incidentally on surgery for other diseases or autopsy. We encountered an incidentally detected subserosal nodule in proximal jejunum during exploratory laparotomy for other cause which was resected and on histopathology confirmed to be HP. Histologically, most of the tumors are located in the submucosa, rarely in the muscularis propria, and only seldom in the subserosal. This case is of great interest because of the subserosal location of the tumor.

A Rare Case of IPMN Arising from Heterotopic Pancreatic Tissue and Gastroenteric Congenital Anomalies

We report a rare case of double Intraductal Papillary Mucinous Neoplasm with multiple foci of adenocarcinoma originating from duodenal and gastric heterotopic pancreatic tissue, associated with gastric duplication and intestinal malrotation.

Gastric neuroendocrine tumor arising from heterotopic pancreas

There are few English reports on secondary tumors from heterotopic pancreas. Here, we describe a case of gastric neuroendocrine tumor (NET) arising from heterotopic pancreas. A 72-year-old woman underwent esophagogastroduodenoscopy as part of a general health check-up. An endoscopic examination revealed a submucosal tumor on the greater curvature of the gastric body. Laparoscopic and endoscopic cooperative surgery was performed. Histological diagnosis concluded that it was a Grade 1 NET arising from heterotopic pancreas. We report this extremely rare case of a NET presenting as a submucosal tumor, considered to have originated from heterotopic pancreatic tissue.

The Double Pylorus

88 year female with medical history of hypertension, type 2 diabetes mellitus, hyperlipidemia, osteoarthritis, gastroesophageal reflux disease and a vague history of peptic ulcer disease (PUD) presented to emergency department with 2 episodes of black stool and increasing fatigue over the past 3 days. She also reported using ibuprofen regularly for osteoarthritic related symptoms. Physical exam and basic laboratory investigations were also normal with the exception of hemoglobin, which was 7g/dL. Esophagogastroduodenoscopy (EGD) demonstrated a large non-bleeding ulcer (15mm in largest dimension) in the antrum. Notably, there was also a second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus (see Fig. 1 and Fig. 2). Double pylorus is a rare endoscopic finding, found in 0.001% to 0.4% of EGD. It is characterized by two openings between the distal stomach and the duodenal bulb. It can be classified as congenital or acquired based on etiology. Congenital double pylorus is usually found in association with other congenital anomalies like heterotopic pancreatic tissue, pancreatic divisum or gastric duplication. The acquired double pylorus (ADP) is usually associated with PUD and results from a prepyloric ulcer or duodenal bulb ulcer eroding into the duodenum or stomach creating a fistulous opening. Additionally, the use of NSAIDS, corticosteroids and persistent H. pylori infection can affect the healing of ulcers and can lead to ADP. Diagnosis is made by endoscopy or occasionally by radiography with the lesser curvature of stomach being the most common location of these fistulous openings. Double pylorus should be differentiated from a gastric diverticulum during endoscopy and can also be mistaken with a large mucosal fold, tumor or polyp during evaluation with upper gastrointestinal series. Treatment of double pylorus consists of promotion of mucosal healing with proton pump inhibitor and less commonly H2 blockers, avoidance of NSAIDS/corticosteroids, and treatment of H. pylori infection. The majority of fistulas do not close (or may only partially close), however endoscopic division of the bridging tissue with a sphinterotome should be considered for patients presenting with gastric outlet obstruction. Surgical intervention is an option for patients with obstruction refractory to endoscopic treatment or the presence of other complications such as perforation or refractory bleeding.Figure: Second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus.Figure: Second luminal opening between the antrum and duodenal bulb adjacent to the ulcer consistent with a double pylorus.

Combined Pancreatic and Gastric Heterotopia Presenting as a Gallbladder Mass: An Under-Recognized Cause of Post-Prandial Right Upper Quadrant Pain

Pancreatic and gastric heterotopias are defined as pancreatic and gastric tissue located outside their anatomic location without vascular or anatomical continuity with the pancreas proper or the stomach. These heterotopias have been described in the esophagus, stomach, and Meckel's diverticulum, however their presence in the gallbladder is rare. Heterotopias in the gallbladder can present with symptoms of acute and chronic cholecystitis, and perforation. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical suspicion of acute cholecystitis. An 18-year-old woman presented with several years of nausea, non-biliary emesis and right upper quadrant pain. Her symptoms were most noticeable post prandial after a high fat meal. She was treated symptomatically for years with ondansetron, promethazine, NSAIDs, and sucralfate without relief. She denied any past medical or surgical history. A previous EGD was unremarkable and biopsies of the stomach and duodenum were negative for metaplasia and dysplasia. A right upper quadrant ultrasound showed a 9.6 mm polyp without sludge or stones. Cholecystectomy was performed and gross specimen showed a 0.9 x 0.7 x 0.6 cm rubbery pink polypoid nodule. Pathology revealed polyploid gastric and pancreatic heterotopia with focal intestinal metaplasia. There was no dysplasia and immunohistochemical stain for helicobacter pylori was negative. Mild chronic cholecystitis and cholesterolosis were present. The incidence of heterotopic pancreatic and gastric tissues ranges from 0.1 to 13 percent in the general population. Though the etiology is no yet well defined, theories suggest it results from an error during embryological development during rotation of the foregut. Acquired forms of heterotopia have been described, particularly gastric metaplasia. Though usually benign, malignant transformation can occur. Heterotopic pancreatic and gastric heterotopia in the gallbladder is difficult to diagnose preoperatively and is usually confirmed by histopathologic examination of the surgically resected specimen. Because pancreatic and gastric heterotopia is rare and often accompanied with nonspecific symptoms, delay in diagnosis occurs. In addition, awareness of this under reported condition by pathologist is important for its identification because should not be diagnosed as neoplastic disease, such as adenoma.Figure: Histology of the gallbladder mass showing combined pancreatic and gastric heterotopia with H&E stain at 20x magnification.Figure: Histology of the gallbladder mass showing combined pancreatic and gastric heterotopia with H&E stain at 400x magnification.Figure: Histology of the gallbladder mass showing combined pancreatic and gastric heterotopia with H&E stain at 400x magnification.

Low Grade Pre-malignant Lesion of Pancreatic Rest in Stomach, Surveillance a Dilemma

INTRODUCTION: Pancreatic intraepithelial lesions (PanIN) are premalignant lesions of pancreatic ductal adenocarcinoma (PDA). PanIN and PDA found in ectopic gastric pancreatic rest tissue are extremely rare, with only two cases of low-grade PanIN in ectopic gastric ectopic pancreatic tissue reported. In this case report, we present a case of PanIN in gastric ectopic pancreatic tissue found after lesion removal by endoscopic mucosal resection (EMR). CASE REPORT: A 47-year-old female with no significant history underwent an upper endoscopy for abdominal pain. Upper endoscopy revealed gastritis in the stomach and a 1 cm subepithelial lesion with central umbilication in the gastric antrum (figure 1). Endoscopic ultrasound examination revealed that the lesion was arising and limited to only the submucosa. EMR was performed to remove the lesion en bloc (figure 1). Pathological examination revealed gastric heterotopic pancreatic tissue and focal pancreatic intraepithelial neoplasia 1A (figure 2). Follow-up surveillance endoscopy performed at 6 months revealed no evidence of recurrence (figure 3).Figure: Endoscopic image showing (Left) A 1 cm submucosal polyp with central umbilication in the antrum. (Middle) Post en-block removal of polyp by endoscopic mucosal resection technique. (Right) Lesion closed with 2 clips.Figure: Histopathologic examination of haematoxylin and eosin stained pancreatic rest tissue specimen under x400 shows that pancreatic duct is lined by a single layer of epithelium with abundant apical mucinous cytoplasm and basal nuclei that lack atypia consistent with Pancreatic Intraepithelial Neoplasia 1A.Figure: Endoscopic image showing a scar tissue in the antrum from prior intervention with no residual pancreatic rest tissue.DISCUSSION: PanIN refers to a small intraductal noninvasive lesion formed by metaplasia and proliferation of ductal epithelium. It is classified by dysplasia severity—PanIN 1 and 2 are low grade, and PanIN 3 is high grade. In orthotopic pancreas, PanIN 3 is known as carcinoma-in-situ. Conversely, PanIN 1 and 2 tumors grow slowly, might take up to 12 years to transition into PanIN 3 and even longer to change to PDA. These results can be extrapolated to pancreatic rest tissue due to similar mutations. Presently, asymptomatic pancreatic rest is monitored, while symptomatic cases—or those suspicious of malignancy on ultrasound—are resected using endoscopic techniques or surgical resection. There are no guidelines for endoscopic surveillance and therapy of these asymptomatic, premalignant and malignant gastric ectopic pancreatic rest lesions. In this case we highlight a very rare incidence of a low-grade premalignant lesion within gastric ectopic pancreatic rest removed by endoscopic resection. Further research is necessary to better define strategies for endoscopic surveillance and therapy of asymptomatic gastric ectopic pancreatic rest given the potentiality of these lesions to be premalignant and transform into malignant lesions that carry a poor prognosis.

Heterotopic pancreas in the omphalomesenteric duct remnant in a 9-month-old girl: a case report and literature review

BackgroundHeterotopic pancreas most commonly occurs in the upper gastrointestinal tract of adults, usually as an incidental finding. It seldom occurs at the umbilicus, and even rarely in the pediatric age group.Case presentationHere we present a case of heterotopic pancreatic tissue in the omphalomesenteric duct remnant of a 9-month-old baby girl. She presented with redness at the base of the umbilicus associated with occasional mild wetness. A urachal fistula was suspected by ultrasound. Histology from subsequent resection revealed fibrous tissue with heterotopic pancreatic tissue and accompanying small bowel mucosa. The patient’s umbilical redness resolved after the surgery.ConclusionsUpon literature search, we found only 17 other cases of heterotopic pancreas reported in the umbilicus. They described a high male to female ratio, frequent association with omphalomesenteric duct remnant and presentation of umbilical discharge. The Heinrich system is frequently used to classify heterotopic pancreas into 3 types, based on the presence of acini, islets and ducts. Several mechanisms have been proposed on the pathogenesis of heterotopic pancreas, including misplacement, metaplasia and totipotent cell theories. Heterotopic pancreas can manifest clinically with diseases of the pancreas, including malignant transformation, reported as high as 12.7% in a series. Awareness of this finding in the biopsy aids the suitable treatment decisions for the patient.

Clinical impact of duodenal pancreatic heterotopia \u2013 Is there a need for surgical treatment?

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.

Heterotopic pancreatic tissue associated with type 1 choledochal cyst, cystolithiasis and gall bladder stones: a rare entity with review of literature

Choledochal cyst is a rare congenital malformation, particularly when associated with stones in cyst (cystolithiasis), gallstones and heterotopic pancreatic tissue within the cyst wall. The current case represents a 5-year-old...

Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications.

Heterotopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separate from the main gland. The most common locations of this displacement include the upper gastrointestinal tract-specifically, the stomach, duodenum, and proximal jejunum. Less common sites are the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Uncomplicated heterotopic pancreas is typically asymptomatic, with the lesion being discovered incidentally during an unrelated surgery, during an imaging examination, or at autopsy. The most common computed tomographic appearance of heterotopic pancreas is that of a small oval intramural mass with microlobulated margins and an endoluminal growth pattern. The attenuation and enhancement characteristics of these lesions parallel their histologic composition. Acinus-dominant lesions demonstrate avid homogeneous enhancement after intravenous contrast material administration, whereas duct-dominant lesions are hypovascular and heterogeneous. At magnetic resonance imaging, the heterotopic pancreas is isointense to the orthotopic pancreas, with characteristic T1 hyperintensity and early avid enhancement after intravenous gadolinium-based contrast material administration. Heterotopic pancreatic tissue has a rudimentary ductal system in which an orifice is sometimes visible at imaging as a central umbilication of the lesion. Complications of heterotopic pancreas include pancreatitis, pseudocyst formation, malignant degeneration, gastrointestinal bleeding, bowel obstruction, and intussusception. Certain complications may be erroneously diagnosed as malignancy. Paraduodenal pancreatitis is thought to be due to cystic degeneration of heterotopic pancreatic tissue in the medial wall of the duodenum. Recognizing the characteristic imaging features of heterotopic pancreas aids in differentiating it from cancer and thus in avoiding unnecessary surgery. © RSNA, 2017.

Heterotopic Pancreatic Tissue in Gall Bladder: A Rare Entity

Introduction: Pancreatic heterotopia is a rare pathological entity and its localization in gall bladder is extremely rare. It is mostly asymptomatic incidental finding and rarely gives rise to complications. It can be associated with incidental finding or can be symptomatic or may cause complication. Heterotopic pancreas (HP) also referred to as ectopic pancreas, pancreatic choristoma, or pancreatic rest, is defined as the aberrantly located pancreatic tissue in an anomalous location without any anatomic, vascular, or neural continuity with the main body of the normal pancreas. The most common location for HP is the duodenum, upper jejunum and stomach. Case report: A 35 year male was admitted to the Surgical Department of Era’s Lucknow Medical College and Hospital for an elective laparoscopic cholecystectomy. He had complains of sporadic flatulence after meals and belching. His gall bladder was resected post an USG revealing Gall stones and sent for histopathology where he was diagnosed as a case of heterotopic pancreas in the GB neck with chronic cholecystitis. Discussion: Localization of pancreatic heterotopia in gall bladder is the second most prevalent pancreatic anomaly but an extremely rare finding. The incidence in gastrointestinal tract is estimated to be from 0.55% to 13.7% on autopsy, and 0.2% in laparatomy. Most commonly these are incidental findings but some studies have implicated them as causative factors in the genesis of cholecystitis, obstructions etc. Conclusion: HP of the gallbladder may cause clinical symptoms such as cholecystitis as well as complications which can be fatal and hence this condition should be taken into consideration in patients with symptomatic gallbladder disease.