Presence Of Pancreatic Tissue Research Articles

Pancreatic Heterotopia in the Biliary Cyst Wall of a Pregnant Patient and Literature Review.

Pancreatic heterotopia is the presence of pancreatic tissue in a different anatomical location with no connection to the main pancreas. The most common locations in the gastrointestinal system are duodenum, stomach, and Meckel diverticulum. However, it is quite rare in the hepatobiliary system. Here we present a patient with pancreatic heterotopia who we treated with left hemihepatectomy and extrahepatic bile duct resection for Todani type 4a bile duct cyst. Heterotopic pancreatic tissue was present in dilated cystic bile ducts on pathological examination. A 22-year-old 26-week pregnant patient presented to the emergency department with right upper quadrant pain. There was massive dilatation of the left lobe bile ducts and common bile duct, and multiple stones were observed distal to the common bile duct. The patient was hospitalized for definitive surgical treatment 4 months after giving birth. The patient underwent left hemihepatectomy, extrahepatic bile duct resection, and hepaticojejunostomy. The postoperative course was uneventful. Pathological examination of the specimen showed heterotopic pancreatic tissues in the wall of the dilated cystic intrahepatic and extrahepatic bile ducts. One of the most accepted hypotheses in the etiology of biliary tract cysts involves the abnormal union of the pancreatic duct and common bile duct. This lesion is unique in the absence of pancreaticobiliary junction anomaly. We think that cystic dilation of intrahepatic and extrahepatic bile ducts is likely secondary to recurrent inflammation due to the release of digestive enzymes by heterotopic pancreatic tissue in the biliary tract. It is also the first example in the literature diagnosed during pregnancy.

Heterotopic pancreas in the jejunum: highlighting the necessity of excision and histopathological confirmation – a case report

Heterotopic pancreas (HP) is a congenital anomaly characterized by the presence of pancreatic tissue that is anatomically separate from the main pancreatic gland without continuity of the duct system and vascularity. The most frequent locations for this displacement are within the upper gastrointestinal tract, particularly in the stomach, duodenum, and proximal jejunum. Other less common sites include the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Typically, uncomplicated heterotopic pancreas does not exhibit symptoms, and the lesion is often discovered incidentally during unrelated surgeries, imaging examinations, or autopsy. This report describes a 35-year-old male with a history of corrosive ingestion who presented with dysphagia. During surgical exploration, a tissue measuring 0.7 × 0.5 cm was observed approximately 40 cm from the DJ flexure in the jejunum. The identified tissue was excised and sent in for histopathological examination (HPE). In conclusion, we advise the excision of the ectopic tissue and recommend HPE because the diagnosis of HP cannot be confirmed without a thorough histopathological examination. Despite its rarity, heterotopic pancreas should be included in the differential diagnosis when evaluating gastrointestinal stromal tumors.

Pathologic examination of ectopic pancreatic tissue in the gallbladder: A case report

Abstract Introduction/Objective Ectopic pancreatic tissue (EPT) is an entity defined by the presence of pancreatic tissue at its non-physiological site, while co-existing with original tissue in its correct anatomical location. While EPT is a rare process in locations such as the stomach, duodenum, and esophagus; it is even more uncommon for it to occur in the gallbladder. To our knowledge, fewer than thirty cases of EPT in the gallbladder have been reported. The following case report presents a 47-year-old woman with ectopic pancreatic tissue in the gallbladder. Methods/Case Report A 47-year-old female presented to our emergency department with her third episode of colicky right upper quadrant pain. Ultrasound imaging demonstrated cholelithiasis with additional ill-defined findings of the gallbladder wall, which included but were not limited to acute emphysematous cholecystitis and chronic cholecystitis with features of porcelain gallbladder. Laparoscopic cholecystectomy was performed without complications. Pathologic evaluation of the specimen demonstrated a cystic structure at the fundus of the gallbladder with coexisting EPT, fundic-type adenomyomatosis, and cholelithiasis. Results (if a Case Study enter NA) NA Conclusion Ectopic pancreatic tissue is a rare incidental finding which is often confused for a malignant process. While it is more commonly seen in the gastrointestinal tract from the esophagus to the duodenum, it can present in other sites such as in this case. Currently, there is no specific imaging method to determine the presence of EPT. Ultrasonography is nonspecific and EPT can be confused for a number of conditions ranging from benign to malignant. Gross examination is fairly unremarkable, however microscopic examination is a straightforward diagnosis. While it is a benign process, malignant transformation can occur and pathologists should be aware of this possibility. For this reason, additional sections may be recommended to rule out occult malignancy.

Annular Pancreas in infancy

: Annular pancreas is a rare congenital disorder where the symptoms that appear in this patient are symptoms of obstruction caused by the presence of pancreatic tissue that forms a ring around the descending part of the duodenum. The annular pancreas has a ratio of 1:20,000 births that may show stenotic or obstructive symptoms early in life. With a plain abdominal radiograph taken in the erect position, a “double bubble” appearance is seen, which is typical of the annular pancreas. In this case , A boy 10 month, with chief complaint vomiting, with containt vomiting every time he eat (breast milk). It had been suffered since he was born. Patient was born by midwife, aterm. Since he born, patient used took antivomitus from pediatric. Patient has been documented by barium meal to hospitalization, and was differential diagnosed with obstruction partial duodenum; duodenal web; pyloric stenosis; annulare pancreas with right scrotalis hernia. In these patient the treatment with perform Duodeno-Jejunustomy. Keywords : Annular pancreas, double bubble, Duodeno-Jejunustomy

Adenoma in Ectopic Pancreas: A Case Report

Introduction: The presence of pancreatic tissue that lacks anatomical or vascular communication with the pancreatic organ has a frequency in autopsy studies that ranges between 0.5% and 13.7%. It is most commonly found in the stomach, specifically in the antrum. Treatment is not clearly established. Surgical resection is recommended in symptomatic patients whose only cause of symptoms is ectopic pancreatic tissue or cancerous formations. Objective: Report a case of ectopic pancreatic adenoma given its low incidence. Case Report: This study reports the case of a 45-year-old male with a history of clinical diagnosis of gastroesophageal reflux disease and a Nissen fundoplication. He presented poor evolution 6 months after the surgery. An endoscopy which revealed postpyloric “polyp” at the level of the duodenal bulb and an inconclusive histopathological study of the same were performed. Reassessment with CT showed a tumor in the first portion of the duodenum measured at 2.2cm, without adenopathies, and a normal-appearing pancreas. It has been made a subtotal gastrectomy and Roux “Y” reconstruction, without complications, with good postoperative evolution, discharged at home on the sixth day. With hematoxylin and eosin technique, the histopathology report reported bile duct adenoma originating in ectopic pancreatic tissue, positive immunohistochemistry for cytokeratin 7 (IHC-7), predominantly expressed by ductal epithelial cells of the pancreatobiliary tract. The patient after surgery had a good clinical evolution and disappearance of symptoms. Conclusion: The clinical cases of rare pathologies are presented to increase the world bibliography and to be able to compare the diagnosis and treatment. In this case, a heterotopic pancreatic adenoma was presented, which is a diagnostic challenge.

An unusual case of heterotopic pancreas in the umbilical sinus of a child

Background: Heterotopic pancreas is the presence of pancreatic tissue outside its normal location, mostly in the gastrointestinal tract. It is rare and most patients are asymptomatic adults. The presence of heterotopic pancreas in the umbilicus and the pediatric age group is even more rare. Case Presentation: An 18-month-old boy presented with clear umbilical discharge since birth. On examination, there was a swollen and inflamed umbilicus. Exploration and excision of the umbilical lesion were done. Histopathological examination of the lesion reported as umbilical sinus with the presence of heterotopic pancreas. He was discharged well with no complications seen on the follow-up review. Conclusions: Heterotopic pancreas is rare. Awareness of this condition is important in order for the patient to be managed accordingly.

Ektopično tkivo pankreasa u želucu - prikaz slučaja

Introduction: Ectopic pancreas is a rare developmental anomaly. It is a presence of pancreatic tissue without anatomic or vascular continuity with the normally developed pancreas. The most common heterotopic site is the stomach commonly involving antrum and prepyloric region on the greater curvature or posterior wall. Ectopic pancreas is diagnosed by endoscopic ultrasound, gastroscopy and biopsy, CT scan and MRI of the abdomen, a definitive diagnosis is verified by histopathological examination. Treatment is surgical. Case report: A 56-year-old woman presented with epigastric pain, nausea and fatigue. Esophagogastroduodenoscopy showed submucosal mass in the prepyloric region, biopsy was performed. Histopathological findings described normal gastric mucosa. Endoscopic ultrasonography and CT of the abdomen showed submucosal tumor, 18 mm in diameter, located in the prepyloric region. Surgical treatment was indicated. Gastrotomy with total extraction of tumor was performed. Histopathology findings showed ectopic pancreatic tissue in the submucosal and muscular layer of the stomach. Postoperatively patient fully recovered, and in the 2 year follow-up did not develop any symptoms related to gastrointestinal tract. Conclusion: Although presentation of ectopic pancreatic tissue in stomach is a very rare condition, it should be considered during gastroitestinal diagnostic in patients with nonspecific gastrointestinal symptomatology. In most of cases, for this patients, surgery is curative and definitive solution.

Heterotropic pancreas in appendix: A rare case report

Heterotopic pancreas is defined as the presence of pancreatic tissue in an abnormal location without any anatomical or vascular continuation with the main body of the pancreas. Most common locations are stomach, duodenum and jejunum. Rare cases have been documented in ileum, omentum, colon, gall bladder, cystic duct, spleen, liver, urinary bladder, lungs, fallopian tube, tongue and submandibular salivary gland. Heterotopic pancreatic tissue located in the appendix is a rare entity. A 65 year old male was operated for intestinal tuberculosis. Appendix attached to the caecum revealed heterotopic pancreatic tissue on histopathological examination. No case of pancreatic heterotopias in appendix has been reported so far to the best of our knowledge.

Diagnosis and treatment of heterotopic pancreas at the angular notch of stomach misdiagnosed as gastric stromal tumor

Heterotopic pancreas is usually defined as a presence of pancreatic tissue without any anatomical or vascular continuity, and is one of the congenital and rare diseases. The clinical manifestations are easily confused with other gastrointestinal diseases, and conventional endoscopic examination cannot provide a clear preoperative diagnosis, therefore heterotopic pancreas is often misdiagnosed. It is very important to distinguish heterotopic pancreas and other digestive diseases. In this article, the clinical characteristics, differential diagnosis and treatment method of one patient with heterotopic pancreas who was admitted to the Affiliated Hospital of Chengde Medical College in March 2014 were analyzed. Key words: Heterotopic pancreas; Gastric stromal tumor; Gastroscopy

Ectopic pancreas in gallbladder. Clinical significance, diagnostic and therapeutic implications

Ectopic or heterotopic pancreas is defined as the presence of pancreatic tissue in an anatomical place not related to the pancreas, being it most frequent locations the stomach and small bowel. Its finding in the gallbladder is exceptional. Since the first case was reported by Otschkin in 1916, about 30 cases have been described in literature. We report the case of a 43 years-old male patient who had an urgent laparoscopic cholecystectomy with the diagnosis of acute cholecystitis, which pathological study showed the existence of chronic cholecystitis with heterotopic pancreatic tissue in the gallbladder wall.

Heterotopic pancreas presenting as ileoileal intussusception.

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. It is a rare condition found mainly in stomach, duodenum and jejunum. Ileal heterotopic pancreas is an uncommon condition and has been rarely reported in children so far. Hereby we report a case of heterotopic pancreas presenting as ileal poyp leading to ileoileal intussusception in a 12 year child.

Gastric Outlet Obstruction Caused by Heterotopic Pancreatitis

Heterotopic pancreas is defined as the presence of pancreatic tissue outside its normal location in the pancreas and lacking vascular and anatomical continuity with the pancreas. Most commonly it is found along foregut derivatives, such as the stomach, duodenum and jejunum. Less often it is found in Meckel's diverticulum and the bile duct or in even rarer locations. It is frequently encountered incidentally in asymptomatic patients during laparotomy, and is found in approximately 0.5–14% of autopsy studies.[1] Symptomatic patients are rare and do not exhibit any specific set of clinical indicators for this disease. Accordingly, heterotopic pancreas is difficult to diagnose before operation.[2] In our case, a 15-year-old girl presented with a short history of vomiting, weight loss, lack of appetite and upper gastrointestinal bleeding. Laparotomy revealed heterotopic pancreas at the duodenum with signs of inflammation and mucosal ulceration.

A rare cause for peritonitis: pancreatic heterotopia

A rare cause for peritonitis: pancreatic heterotopia

Gastric Outlet Obstruction Due to Secreting Heterotopic Pancreas

Purpose: Introduction: Heterotopic pancreas (also termed as pancreatic rests) is a rare congenital anomaly of the gastrointestinal tract. Presence of heterotopic pancreatic tissue within the stomach is a rare cause of gastric outlet obstruction. We report an interesting case of gastric outlet obstruction as a complication of heterotopic pancreas presenting as a submucosal cyst in the gastric antrum diagnosed with endoscopic ultrasound (EUS). Case report: A 22 year old female with history of gastroesophageal reflux disease presented with 6 week history of progressively worsening nausea, emesis, heartburn and early satiety with weight loss. Esophagogastroduodenoscopy to the descending duodenum revealed a large, submucosal antral gastric lesion with partial gastric outlet obstruction. Abdominal computer tomography showed a 4 cm×2.7 cm low-density mass in the distal stomach. Subsequent EUS demonstrated a large 5 cm submucosal cystic lesion in the gastric antrum in layer three. EUS guided fine needle aspiration of the cyst revealed amorphous material. Biochemical studies of the fluid showed elevated amylase level with a value of 4,878 U/L and a CEA level of 96.6 ng/ml. Due to persistent symptoms, patient subsequently underwent distal gastrectomy with Roux-En-Y anastomosis. Final histological diagnosis showed gastric heterotopic pancreas. Discussion: Heterotopic pancreas is defined as the presence of pancreatic tissue outside normal pancreas that lacks anatomic or vascular continuity with main pancreas itself. Most common sites for heterotopic pancreas are stomach (25-38%), duodenum and jejunum. Complications include mechanical obstruction like gastric outlet obstruction in our patient, cyst formation, acute or chronic pancreatitis, bleeding due to ulceration and malignant transformation. Differential diagnosis of gastric submucosal lesions includes gastrointestinal stromal tumors, duplication cyst, lymphoma and gastric carcinoma. On endoscopy, heterotopic pancreas appears as a broad based submucosal lesion that may have umblication on the mucosal surface indicating the site of draining duct. EUS has proven to be very useful in diagnostic evaluation. Fine needle aspiration via EUS allows cytological evaluation of submucosal lesions which can usually confirm the diagnosis. Definite diagnosis of pancreatic heterotopia is by histology of the lesion. Symptomatic lesions are treated surgically. Submucosal lesions of gastrointestinal tract present a diagnostic challenge for gastroenterologists. Heterotopic pancreas, albeit a rare entity, should be considered in cystic lesions of gastric wall causing gastric outlet obstruction.

Incidental Adenomyoma of Stomach Associated with Early Gastric Cancer

An adenomyoma of the gastrointestinal tract is a rare, benign, tumor-like condition histologically characterized by glandular structures embedded within a smooth muscle stroma. An adenomyoma has been considered to be as an abortive variant of an ectopic pancreas. An ectopic pancreas is defined as the presence of pancreatic tissue that lacks anatomic and vascular continuity with the main body of the pancreas. Common sites of an ectopic pancreas are the stomach, duodenum, and upper jejunum. An adenomyoma may rarely undergo a malignant transformation or cystic dystrophy. Recently, the authors an experienced a case of an incidental adenomyoma of the stomach associated with early gastric carcinoma. We report that case here.

Gastric outlet obstruction secondary to heterotopic pancreas in the antrum: Case report and review

Heterotopic (aberrant) pancreas, a rare entity, is defined as the presence of pancreatic tissue without anatomic and vascular continuity with the pancreas itself. It can occur anywhere in the GI tract. 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar In most cases heterotopic pancreas does not cause symptoms, 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar but it can occasionally present as dyspepsia, 1 Armstrong CP King PM Dixon JM Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. B J Surg. 1981; 68: 384-387 Crossref PubMed Scopus (181) Google Scholar ectopic pancreatitis, 2 Burke GW Binder SC Barron AM Dratch PL Ulmas J. Heterotopic pancreas: gastric outlet obstruction secondary to pancreatitis and pancreatic pseudocyst. Am J Gastroenterol. 1989; 84: 52-55 PubMed Google Scholar upper GI bleeding, 3 Covarelli P Cirocchi R Bellochi R Ricci P Morozzi B Nonno S et al. Upper digestive hemorrhage as a rare manifestation of ectopic pancreas with gastric localization. G Chir. 1997; 18: 97-100 PubMed Google Scholar and as an inflammatory abdominal mass. 4 Kaneda M Yano T Yamamoto T Suzuki T Fujimori K Itoh H et al. Ectopic pancreas in the stomach presenting as an inflammatory abdominal mass. Am J Gastroenterol. 1989; 84: 663-666 PubMed Google Scholar Rarely, heterotopic pancreas has been reported as the cause of gastric outlet obstruction. 5 Kreig EG. Heterotopic pancreatic tissue producing pyloric obstruction: a review and case Report. Ann Surg. 1941; 113: 364-370 Crossref PubMed Google Scholar , 6 DeBord JR Majarakis JD Nyhus LM. An unusual case of heterotopic pancreas of the stomach. Am J Surg. 1981; 141: 269-273 Abstract Full Text PDF PubMed Scopus (39) Google Scholar This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum.

ENTERIC DUPLICATIONS-Reply

To the Editor .—Dr. Szalay's letter emphasizes a point made in our paper that, do not believe that all enteric duplications are derived by such a pathogenetic scheme (in-utero vascular abnormality). We concur with the need for such emphasis. The presence of pancreatic tissue in gastric duplications is unexplained on firm scientific grounds although one could arm-chair postulate all sorts of dysembryogenetic influences.

Aberrant Pancreatic Tissue in the First Portion of the Duodenum

The presence of pancreatic tissue in an aberrant location is being reported with increasing frequency and can no longer be considered a rare postmortem or surgical finding. Such tissue, moreover, is often responsible for symptoms, which are sometimes severe. A recent classic review and contribution to the subject from the Mayo Clinic lists 21 of 41 histologically authenticated cases as having been clinically significant (1). The formation of aberrant (accessory or heterotopic) pancreatic tissue is usually considered to be due to defective embryologic development. Horgan (2) believed that during early development the branching ducts of the body of the pancreas become engrafted on contiguous organs during the migration of the latter and before the coalescence of the primitive pancreatic anlagen, and that this graft is pulled off and forms an intramural mass. Warthin (3) held that the rudimentary pancreatic ducts penetrate the intestinal wall by lateral budding and are separated by longitudinal growth of the intestine. The possibility that the aberrant tissue is due to anaplasia of intestinal mucous membrane may also be mentioned, but only for the sake of completeness. The aberrant pancreatic tissue is usually in the form of a single firm nodule, measuring about 1.0 to 4.1 cm. in diameter. It is most commonly found beneath the mucous membrane and frequently infiltrates the muscle fibers. The nodule is usually sessile; it may be lobulated and present a granular surface. The appearance on cut section is glandular, and the color is white to yellow. Case Report T. B. S., a 24-year-old white male, was admitted to the hospital March 17, 1949, complaining of heartburn and dull epigastric pain occurring shortly after meals. In 1943, while in the Army in North Africa, he had been hospitalized for three weeks, following constipation for one week and an episode of severe vomiting. Subsequently the present symptoms developed. The patient complained of the frequent passage of gas, orally and rectally, especially after eating fried and greasy foods. He was taking milk of magnesia after each meal to relieve his “indigestion” and insure a daily bowel movement. In 1945, the patient had been given a 60 per cent disability discharge from the Army for hepatitis, psychoneurosis, and right renal stones. Cystoscopy had since been done at two hospitals, and there is a possibility that stones were removed. Two weeks before admission a diagnosis of polyp of the first part of the duodenum was made on two different occasions, in another hospital. The patient appeared well nourished and, except for slight epigastric tenderness, physical examination was not significant. The laboratory findings, including liver function tests and gastric analysis, were within normal limits. The blood pressure was 140/88. No tests were done for pancreatic function.

A Microscopic Study of the Pancreas in Fishes; Especially Those of the Orders Haplomi and Cyprinodontes

T HE existence of a relationship between the secretory function of the pancreas and pancreatic control of carbohydrate metabolism was demonstrated by the author in earlier publications and has been since confirmed by others: Boldyreff (1927, 1930, 1932, 1934), Coelho and Oliveria (1928), Okada, et al. (1928), Burge (1931). The wide variations in the amount and the distribution of glandular tissue, and the differences in arrangement of secretory cells in the pancreas of teleosts, as well as the variations in the structure of the gland as a whole in this group of vertebrates, offer an interesting field of study and may serve as a source of information concerning the relation of pancreatic structure to the functional activity of this organ. These considerations served as a starting point for the present investigation. The final selection of Esox, Umbra and Fundulus was made at the suggestion of Prof. Carl L. Hubbs at the University of Michigan, who was interested in these studies from the phylogenetic point of view. Esox and Umbra are known to be closely related; these fishes are also known to be definitely carnivorous (Adams and Hankinson, 1928). The alleged relation of Fundulus to the pikes has never been firmly established and has recently been questioned by Hubbs and others (see below). According to Linton (1901), the alimentary canals of Fundulus are usually filled with vegetable matter; therefore it may be concluded that the animal is largely vegetarian. Brunelli (1928) published an article dealing with the physiology and anatomy of the pancreas and liver in fishes. This author's contention was that there are two functionally different types of liver in fishes: (1) the hepatopancreas, present in those feeding on carbohydrate food (including mollusks), and containing large amounts of glycogen; (2) livers free from invasion by pancreatic tissue, which mainly store oil, and which are characteristic of carniverous fishes. Brunelli was inclined to believe that the presence of pancreatic tissue within the liver has a functional significance-the internal secretion of the pancreas may greatly facilitate the storage of glycogen. It is worthy of note, however, that the hepatopancreas organs of the fishes described in this report were found to be devoid of islet tissue.

Organography of Gambusia patruelis (baird and girard)

AbstractThe left side of the coelom of the fish is occupied by the large liver and the right side by the remaining digestive organs. The alimentary tract makes one complete coil upon itself in the coelom and terminates in an anus behind the ventral fin. The spleen is in a position dorsolateral to the liver, and its typical histological structure is modified by the presence of pancreatic tissue. The pancreas is scattered through the mesenteries of the organs in this region.The swim bladder is dorsal to the visceral organs and outside of the abdominal peritoneum. It is extensively bifurcated in the male, but only slightly bifurcated in the female.The two kidneys lie posterior to the gills and ventral to the spinal column. Two wolffian ducts arise from their posterior ends and extend posteriorly, uniting near the end of the coelom to form one duct which extends to the urinary bladder which opens into the urogenital sinus.The gonads are posterior to the anterior portion of the digestive tract. Posteriorly, the gonads open into the urogenital sinus which opens anterior to the anal fin.The anatomy of the circulatory system is unusual in that the dorsal aorta is situated on the left side of the spinal column. The right posterior cardinal vein remains as the continuation of the caudal vein.