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Needle core biopsies: (a) intraductal papilloma on needle core biopsy (h&E, original magnification x 100). (B) intraductal papilloma with sclerosis (h&E, original magnification x 400).
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Ectopic pancreas is defined as pancreatic tissue outside the normal location without connection to the normal pancreas. It occurs throughout the gastrointestinal tract, most commonly in the stomach (25-60%), followed by the duodenum (25-35%) and jejunum (16%). It may develop the same pathological changes of a normal pancreas such as acute pancreati...
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... 2012, a 55-year-old woman with a history of colonic adenocarcinoma presented with a left lung mass asso- ciated with mediastinal lymphadenopathy (Fig. 1). The clinical features suggested exclusion of a lung origin carcinoma. The endoscopic biopsy showed an adeno- carcinoma with enteric features. The immunohisto- chemistry profile showed widespread positive staining in neoplastic cells for the following markers: TTF-1, CDX-2 and CK20 (Fig. 2 The lung is a frequent site of metastatic involvement, and in many cases the differential diagnosis between a metastasis and a pri- mary carcinoma is a substantial question. TTF-1 is considered as a reliable marker for differential diagnosis in distinguishing primary lung carcinoma and metastasis, especially when dealing with an adenocarcinoma or a large-cell carcinoma. It was gener- ally thought that adenocarcinomas arising in the gastrointestinal tract do not express TTF-1. Recently, it has been reported that a small percentage (1.8%-5.8%) of intestinal adenocarcinoma TTF-1 positive show differences in sensitivity/specificity depend- ing on the antibody clones. We report a case of lung localization of a TTF-1 positive adenocarcinoma in a patient with a history of colon adenocarcinoma. Based on the current results and pre- vious reports, we propose the following criteria for diagnosing lung metastasis from TTF-1 positive intestinal adenocarcinoma. 1) Clinical features and anamnestic history are diagnostic mile- stones, and provide very important information as a prognostic parameter of primary carcinoma and the time interval between the two localizations (primary and ...
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... article did not receive any grant or any other form of financial support. 1. Normal pancreatic tissue is present within and near the adenocarcinomatous glands. h.E. 10x. ...
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... of sections showed a diverticular structure with small bowel mucosa with a peridiverticular, mono-and multinucleated histiocytic granulomatous inflamma- tory reaction, consistent with foreign-body giant cells (Fig. 1). Also identified were hyaline rings and circu- lar structures containing calcified basophilic granules (Fig. 2), confirmed by von Kossa stain. No gastric mu- cosa was identified. A Congo red stain was negative for amyloid deposition. Grocott's methenemine silver (GMS), periodic acid schiff (PAS), Ziehl-Neelsen stains were negative for fungal organisms and mycobacteria, respectively. Parasitic organisms were not identified. Polariscopy failed to detect vegetable ...
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... patients were symptomatic with respiratory symptoms in 4 cases, signs of heart failure in one and conscious trouble in the remaining patient. Four patients had a past medical history consistent with hypertension in 3 cases, renal failure in one (# 3) and diabetes mellitus in one case (# 4). Trans-oesophageal ultra-sound examination was performed in all patients and revealed a mobile mass lo- cated in the right atrium in one case and in the left atrium in 5 cases (Fig. 1a). CT was performed in one patient (# 1), and MRI was performed in 2 patients (# 4, 6). These investigations allowed to rule out a presumed thrombus and highlighted the possibility of a myxoma (Fig. 1b). All patients were treated surgically. The surgical approach consisted in a median sternotomy, and all tumours were completely resected. Gross features were similar in all cases and consisted in a gelatinous but non-friable lesion with a mean size of 20 mm (Fig. 1c). Microscopic features consisted in prominent spindle/ovoid/stellate cells orga- nized around blood vessels, with a background of blue- grey mucopolysaccharide ground material (Fig. ...
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... patients were symptomatic with respiratory symptoms in 4 cases, signs of heart failure in one and conscious trouble in the remaining patient. Four patients had a past medical history consistent with hypertension in 3 cases, renal failure in one (# 3) and diabetes mellitus in one case (# 4). Trans-oesophageal ultra-sound examination was performed in all patients and revealed a mobile mass lo- cated in the right atrium in one case and in the left atrium in 5 cases (Fig. 1a). CT was performed in one patient (# 1), and MRI was performed in 2 patients (# 4, 6). These investigations allowed to rule out a presumed thrombus and highlighted the possibility of a myxoma (Fig. 1b). All patients were treated surgically. The surgical approach consisted in a median sternotomy, and all tumours were completely resected. Gross features were similar in all cases and consisted in a gelatinous but non-friable lesion with a mean size of 20 mm (Fig. 1c). Microscopic features consisted in prominent spindle/ovoid/stellate cells orga- nized around blood vessels, with a background of blue- grey mucopolysaccharide ground material (Fig. ...
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... patients were symptomatic with respiratory symptoms in 4 cases, signs of heart failure in one and conscious trouble in the remaining patient. Four patients had a past medical history consistent with hypertension in 3 cases, renal failure in one (# 3) and diabetes mellitus in one case (# 4). Trans-oesophageal ultra-sound examination was performed in all patients and revealed a mobile mass lo- cated in the right atrium in one case and in the left atrium in 5 cases (Fig. 1a). CT was performed in one patient (# 1), and MRI was performed in 2 patients (# 4, 6). These investigations allowed to rule out a presumed thrombus and highlighted the possibility of a myxoma (Fig. 1b). All patients were treated surgically. The surgical approach consisted in a median sternotomy, and all tumours were completely resected. Gross features were similar in all cases and consisted in a gelatinous but non-friable lesion with a mean size of 20 mm (Fig. 1c). Microscopic features consisted in prominent spindle/ovoid/stellate cells orga- nized around blood vessels, with a background of blue- grey mucopolysaccharide ground material (Fig. ...
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... patients were symptomatic with respiratory symptoms in 4 cases, signs of heart failure in one and conscious trouble in the remaining patient. Four patients had a past medical history consistent with hypertension in 3 cases, renal failure in one (# 3) and diabetes mellitus in one case (# 4). Trans-oesophageal ultra-sound examination was performed in all patients and revealed a mobile mass lo- cated in the right atrium in one case and in the left atrium in 5 cases (Fig. 1a). CT was performed in one patient (# 1), and MRI was performed in 2 patients (# 4, 6). These investigations allowed to rule out a presumed thrombus and highlighted the possibility of a myxoma (Fig. 1b). All patients were treated surgically. The surgical approach consisted in a median sternotomy, and all tumours were completely resected. Gross features were similar in all cases and consisted in a gelatinous but non-friable lesion with a mean size of 20 mm (Fig. 1c). Microscopic features consisted in prominent spindle/ovoid/stellate cells orga- nized around blood vessels, with a background of blue- grey mucopolysaccharide ground material (Fig. ...
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... resected adenoid specimen consisted of mul- tiple pieces of creamy colored tissues, in total 3 x 2.5 x 1 cm (Fig. 1). Microscopic study revealed lymphoid tissue that was involved by numerous gran- ulomatous lesions with central caseating necrosis and multinucleated giant cells both Langhans and foreign body types (Fig. 2); tuberculosis was suggested. At Ziehl-Neelson staining a few acid-fast bacilli were present (Fig. 3). PCR also was done on the specimen, and the result was positive. The patient was visited 10 days after surgery. Snoring was decreased, there was no otorrhoea or any com- plication of left ear, but multiple lymphadenopathies were detected at anterior jugular and posterior trian- gle lymph nodes bilaterally. Chest X-ray was normal (Fig. 4). The patient continued to have low-grade fever during this time. Based on pathological and clinical findings, he was hospitalized and received anti-tuber- culosis treatment that was continued and completed af- case ...
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... 1. A 16-year-old female with no significant past medical history presented with complaints of pelvic pain and menstrual irregularity lasting three years. Pel- vic examination revealed a tumour mass in the left iliac fossa. Ultrasonography demonstrated a well-delineated heterogeneous predominantly solid mass of the left ovary (Fig. 1). The right ovary was normal. All tumour markers and serum hormonal levels were within normal range. The mass was diagnosed as benign by frozen sec- tion analysis and removed by salpingo-oophorectomy. The surgical specimen was an oval, sharply demarcated mass with a smooth and intact outer surface measuring 15 x 11 x 7 cm. The cut surface revealed solid, cystic and oedematous areas. No haemorrhage or necrosis ...
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... to its initiation, this study was reviewed and ap- proved by the Institutional Review Board Committee (IRB) at the parent institution, St. John Hospital and Medical Center in Detroit, Michigan (USA). We ret- rospectively reviewed our laboratory information sys- tem database for all cases of adult female patients di- agnosed on needle core biopsy with papillary lesions of the breast between January 2001 and June 2011. A comprehensive search of needle core biopsies of the breast with any combination of the words "papillary", "breast", and "lesion" in the main diagnostic line re- turned 98 results. Of these, 91 archival routinely-pro- cessed, formalin-fixed, paraffin-embedded surgical pathology specimen cases with follow-up resection specimens available for histologic evaluation were re- trived; they included all histologic subtypes of papil- lary lesions of the breast. Twenty-nine of these (mean patient age 54.93 ± 12.5 SD) were reported as benign papillary lesions (Fig. 1), and the remaining 62 (mean patient age 61.98 ± 15.20 SD) were diagnosed as either atypical papillary lesions (17 cases) or malignant pap- illary lesions (45 cases) (Figs. 2, 3, 4). The remaining seven cases were diagnosed either as atypical papillary lesion or frankly malignant on needle core biopsy, and follow-up specimens were unavailable. These seven cases were not included in our study. The 29 benign lesions were not associated with any atypical features, carcinoma in-situ, or invasive carcino- ma. The 17 atypical lesions generally exhibited a greater extent of epithelial proliferation with florid hyperplasia and atypical architectural patterns, but the degree of atypia did not meet the diagnostic threshold for in-situ or invasive carcinoma. The presence and specific loca- tion of associated atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH) was documented. The 45 malignant lesions diagnosed as in-situ or inva- sive carcinoma demonstrated irrefutable features of ma- ...
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... stenosing the wall. On microscopic examination, it consisted of neoplastic glands dispersed into a desmo- plastic stroma invading the entire thickness of the wall and extending into the periparietal soft tissue. The de- gree of differentiation varied from well-formed glands with mucinous cytoplasm and minimal cytologic atypia to poorly formed glands and cells with marked cytologic atypia infiltrating singly or forming solid sheets. Nor- mal pancreatic tissue with acini, ducts and islet cells was present within and near the adenocarcinoma (Fig. 1). Some of these ducts showed pancreatic intraepithelial neoplasia, PanIN-2, with uniform columnar cells and basally located uniform nuclei and papillary architec- ture (Fig. 2). The patient was discharged 10 days after the operation without any complications. At present, the patient is in a good clinical condition. The last CT scan (September 2012) showed multiple hepatic metastases. Chemotherapy was not performed due to the advanced age of the ...
Similar publications
Pancreatic cancer is associated with a very poor prognosis highlighted by the close association between the disease incidence and mortality. Pancreatic cancer commonly metastasizes to the liver, peripancreas, common bile duct, stomach, duodenum, and retroperitoneum. Conversely, rectal metastasis from pancreatic cancer is extremely rare. We report a...
Citations
... Although the disease is usually insidious and asymptomatic, some patients may experience abdominal pain, nausea, and vomiting. Heterotopic pancreas is often identified during other abdominal procedures or by accident during imaging examinations or autopsy and is more common in middle-aged males [2,3]. Ectopic pancreatic tissue also has the possibility of malignant transformation [4,5]. ...
Background:
Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic tumor and has the potential to become malignant. Surgery is the most effective treatment at present, but there is no consensus on the site of resection. Heterotopic pancreas occurs in the gastrointestinal tract, especially the stomach and duodenum but is asymptomatic and rare. We report a case of ectopic pancreas with IPMN located in the jejunum.
Case summary:
A 56-year-old male patient suffered from severe pain, nausea and vomiting due to a traffic accident and sought emergency treatment at our hospital. Contrast-enhanced computed tomography of the whole abdomen suggested splenic congestion, which was considered to be splenic rupture. Emergency laparotomy was performed, and the ruptured spleen was removed during the operation. Unexpectedly, a cauliflower-like mass of about 2.5 cm × 2.5 cm in size was incidentally found about 80 cm from the ligament of Treitz during the operation. A partial small bowel resection was performed, and postoperative pathology confirmed the small bowel mass as heterotopic pancreas with low-grade IPMN.
Conclusion:
Ectopic pancreas occurs in the jejunum and is pathologically confirmed as IPMN after surgical resection.
... The vast majority of lesions are detected incidentally. Heterotopic pancreas is rarely symptomatic, but it can manifest as abdominal pain, gastrointestinal bleeding, obstruction, and acute or chronic pancreatitis, and rare cases of malignant transformation have also been described [1][2][3][4] . Heterotopic pancreatic tissue is usually located in the submucosa and/or the muscularis or subserosa. ...
Background:
Heterotopic pancreas is defined as pancreatic tissue located outside the pancreatic parenchyma that lacks an anatomic or vascular connection to the normal pancreas. Symptomatic gastric heterotopic pancreas is a rare condition that can manifest as acute or chronic pancreatitis. Asymptomatic heterotopic pancreas does not require treatment, while symptomatic lesions should be resected. The modality of final resection of heterotopic pancreas depends on its size and the depth of gastric wall involvement.
Methods and results:
A 36-year-old woman was admitted for recurrent epigastralgia. Abdominal computed tomography (CT) scan revealed that an abscess had formed in the gastric antrum. After multidisciplinary discussion we decided for conservative treatment with intravenous antibiotics and further detailed endoscopic diagnostic. Esophagogastroduodenoscopy revealed a submucosal mass with a central fistula and intermittent pus secretion in the prepyloric region of the gastric antrum, which was subsequently drained with a double pigtail stent under endoscopic ultrasound (EUS) and fluoroscopy. The possibility of pancreatic fluid collection in the case of heterotopic pancreas was suggested during the EUS examination, and histology subsequently confirmed heterotopic pancreatic tissue. The patient was in good condition and without any abdominal pain. According to a control CT scan after 10 weeks, the fluid collection was completely resolved. Due to the possible recurrence of pancreatitis, resection of heterotopic pancreas was proposed to the patient. Since the lesion involved the muscularis propria of the gastric wall, surgical resection of the mass was indicated.
Conclusion:
Fluid collections after acute pancreatitis in heterotopic pancreas in the gastric antrum can be successfully managed by endoscopy.
... (3) Non-neoplastic pancreatic tissue must comprise at least fully developed acini and ductal structures. We found 12 other case reports of HP cancer on PubMed records from the year 2000 to 2020, as shown in Table 1 [3,5,[7][8][9][10][11][12][13][14][15]. In those reports, the patients' mean age was 69.7 years (range, 56-86 years). ...
Background:
Heterotopic pancreas (HP) is defined as pancreatic tissue in organs with no anatomical continuity with the orthotopic pancreas. Based on the number of cases reported in the literature between the year 2000 and 2020, HP is rarely found causing malignant transformation of the duodenum. We herein report a case of adenocarcinoma arising from the HP in the first portion of the duodenum.
Case presentation:
A 77-year-old Japanese man presented to our hospital with epigastric pain. Despite having undergone laparoscopic surgery for early sigmoid colon cancer a month earlier, serum levels of tumor-specific antigens, such as CA19-9, were elevated. After undergoing a series of radiologic examinations, the first portion of the duodenum was found thickened. However, a biopsy of the lesion showed no malignancy. Four months later, follow-up computed tomography (CT) scans showed that the lesion was thicker and involved the gastroduodenal artery (GDA), suggesting tumor invasion. A new biopsy did not detect the malignancy. However, serum tumor-specific antigen levels increased, especially duke pancreatic monoclonal antigen type 2 (5287 U/mL), in the absence of tumor in the orthotopic pancreas. The follow-up CT imaging showed a malignant tumor in the first portion of the duodenum. Five months later, we performed a subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) for duodenal or HP cancer in the first portion of the duodenum, finding a lesion from the pyloric bulbs to the first portion of the duodenum, which invaded the adjacent pancreas and GDA. The pathological examination of the specimens revealed adenocarcinoma arising from HP. Nine months after surgery, no recurrence was found by radiologic imaging or tumor-specific antigen laboratory testing.
Conclusions:
HP adenocarcinoma is rare and difficult to diagnose preoperatively due to its submucosal location. Therefore, a careful follow-up with blood testing and radiologic imaging, as well as diagnostic surgery, is recommended.
... To the best of our knowledge, 52 cases of malignant transformation arising from an ectopic pancreas, including the present case, have been reported in PubMed (keywords: ectopic OR heterotopic OR aberrant pancreas, carcinoma), 14 of which were malignant transformation arising from an ectopic pancreas in the duodenum (Table 1) [13][14][15][16][17][18][19][20][21][22][23]. The mean age of the patients in this group was 70.2 years (range 56-86 years), and eight patients were males and six were females. ...
Background:
The malignant transformation of an ectopic pancreas in the duodenum is extremely rare. Herein, we report a case of an adenocarcinoma that arose from an ectopic pancreas. We also reviewed 14 cases of malignant transformations arising from an ectopic pancreas in the duodenum that were previously published.
Case presentation:
An 81-year-old man with a 1-month history of vomiting was admitted to our institution. Esophagogastroduodenoscopy (EGD) and computed tomography (CT) scans revealed an obstruction at the first part of the duodenum. A distal gastrectomy was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed adenocarcinoma that arose from an ectopic pancreas (Heinrich type 1). The patient is alive without relapse at 18 months of follow-up.
Conclusions:
Adenocarcinoma that arises from an ectopic pancreas should be considered when an obstruction is identified in the duodenum.
... There was no recurrence of pancreatitis after surgery. Patients with EP are reported to develop severe complications, including pancreatitis, perforation and malignant degeneration (1)(2)(3). Surgical resection should be considered in case of symptomatic EP. ...
... Развитие злокачественного процесса -довольно редкое явление, оно происходит в 0,7-1,8% всех случаев ГТПЖ. Аномалия может вызывать подозрение на наличие злокачественного процесса в том или ином отделе ЖКТ, забрюшинном пространстве в связи с выявлением масс-эффекта при КТ [15][16][17] Найденные в доступной литературе работы по выявлению ГТПЖ основаны на данных КТ, эндоскопии. Сообщения о роли магнитно-резонансной томографии (МРТ) в выявлении ГТПЖ отсутствуют, что делает актуальным изучение данного вопроса. ...
... Все авторы отмечают сложности прижизненного выявления эктопии ПЖ [15][16][17]. В описываемых случаях для распознавания ГТПЖ использовались КТ, рентгенологическое исследование ЖКТ, гастроскопия, ультразвуковая эндоскопия с биопсией, однако эти методы позволяют выявить эктопированную ткань при подслизистом расположении в верхней части ЖКТ [18]. Распознать ГТПЖ на уровне тощей, подвздошной кишки в подавляющем большинстве случаев удавалось только после оперативного вмешательства [19,20]. ...
A rare clinical observation of retroperitoneal ectopy of pancreatic tissue with diligence to the kidney and jejunum is presented. For the first time, semiotics of ectopia is described according to the data of magnetic resonance imaging, which allows to determine with a high degree of reliability the belonging of the revealed structures to the tissues of the pancreas.
... Malignant transformation of HP has been reported, although it is difficult to determine its true incidence. [14,15] Postoperative follow-up is necessary for these patients. In our case, no similar pain occurred in the patient's left waist again after discharge. ...
Rationale:
The incidence of heterotopic pancreas (HP) is relatively rare and mainly found in the upper gastrointestinal tract, and no case of HP cyst in the adrenal gland has been reported. Informed consent has been obtained from the patient for the publication of the case details.
Patient concerns:
A 21-year-old woman who presented with chronic lower back pain for a week without urinary disturbance or gastrointestinal discomfortable.
Diagnoses:
Ultrasound (US) revealed a left renal cyst, and computed tomography (CT) showed a cyst in the area of the adrenal gland.
Interventions:
Cystectomy was successfully performed laparoscopically. Histopathologic examination of the removed cyst wall showed heterotopic pancreatic cyst accompanied by cystic degeneration.
Outcomes:
No unusual drainage or abdominal signs were observed during the 6-month follow-up.
Lessons:
Despite of its rarity, HP accompanied by cyst formation in the adrenal gland area can present with waist pain. Therefore, the possibility of such disease needs to be considered. For thorough evaluation, in addition to abdominal US, CT, and/or magnetic resonance imaging, histopathological examination should sometimes be performed to make a definite diagnosis. Total excision and regular follow-up is necessary for such cases due to the potential risk of complications or recurrent cyst formation.
... Preoperative diagnosis of ectopic pancreas malignancy may be difficult with imaging studies. The prognosis of adenocarcinoma arising from ectopic pancreas is not clear [13][14][15][16][17][18][19][20]. However, the prognosis may be better than that of primary pancreatic carcinoma, probably due to the earlier clinical presentation of the carcinoma in ectopic pancreas [21]. ...
We report a case of a vesicoenteric fistula arising from an adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum in a 58-year-old man. The patient suffered from refractory micturition pain and increased urinary frequency. Computerized tomography with a contrast agent showed a ring-shaped enhanced mass near the dome of the urinary bladder. Magnetic resonance imaging showed a cystic mass close to the urinary bladder with partly irregular wall and fistula formation to the urinary bladder. Surgical findings showed a Meckel diverticulum in the ileum, which formed a fistula with the urinary bladder, and Meckel diverticulectomy and partial cystectomy were performed. Histological findings revealed a vesicoenteric fistula arising from a papillary adenocarcinoma of ectopic pancreatic tissue in a Meckel diverticulum. The patient has survived without recurrence for more than 4 years since surgery.
... abdominal pain. Ectopic pancreatic tissue is often located in the stomach (25-60%) but also in the jejunum (16%) [2] and rarely in the spleen. The occurrence of a mucinous cystadenoma in ectopic pancreatic tissue is even rarer and has not been described in the literature. ...
We report the case of an 87-year-old woman admitted for acute abdominal pain and faecal vomiting for four days due to intestinal obstruction. Her medical history revealed an early stage breast tumour operated in 2000, idiopathic pulmonary fibrosis with partial lobectomy in 2004 and hysterectomy in 2001. Clinical examination of the abdomen showed signs compatible with bowel obstruction. The diagnosis of small bowel ileus was confirmed on the abdominal CT-scan. The treatment was at first conservative with nasogastric tube and administration of Gastrografin® showed no improvement. An extensive adhesiolysis was performed through midline laparotomy. A 2.5 cm in diameter, soft nodule was identified on the wall of the proximal jejunum. The nodule was stapler removed without narrowing the jejunal lumen. The postoperative course was uneventful. The histopathological examination showed exocrine and endocrine ectopic pancreatic tissue and a small mucinous cystic adenoma gastric type (Figs. 1, 2 a,b). Ectopic pancreatic tissue is a rare, mainly incidental finding with a prevalence of 0.25% in the general population [1]. When symptomatic, it may cause bleeding, ileus or unspecific abdominal pain. Ectopic pancreatic tissue is often located in the
stomach (25-60%) but also in the jejunum (16%) [2] and rarely in the spleen. The occurrence of a mucinous cystadenoma in ectopic pancreatic tissue is even rarer and has not been described in the literature.
This is to our knowledge, the first description of a mucinous cystic adenoma in ectopic pancreatic tissue.
... In symptomatic cases, surgical excision relieves symptoms. However, rarely, a more extensive treatment may be necessary due to secondary pancreatic neoplasms including adenocarcinomas arising within ectopic pancreatic tissue 101,[107][108][109][110][111][112] . ...
The pancreas is a complex organ that may give rise to large number of neoplasms and non-neoplastic lesions. This article focuses on benign neoplasms, such as serous neoplasms, and tumorlike (pseudotumoral) lesions that may be mistaken for neoplasm not only by clinicians and radiologists, but also by pathologists. The family of pancreatic pseudotumors, by a loosely defined conception of that term, includes a variety of lesions including heterotopia, hamartoma, and lipomatous pseudohypertrophy. Autoimmune pancreatitis and paraduodenal (“groove”) pancreatitis may also lead to pseudotumor formation. Knowledge of these entities will help in making an accurate diagnosis.
