Páncreas ectópico, una posible y rara causa de hipoglucemia postprandial / Ectopic pancreas, a possible rare cause of postprandial hypoglycemia

Introducción: El páncreas ectópico es la segunda anomalía congénita pancreática más frecuente después del páncreas divisum. Fue descrito por primera vez en 1729 por Schultz y se define como la presencia de tejido pancreático que carece de comunicación anatómica o vascular con el cuerpo principal del páncreas. La localización más frecuente es en el estómago (25 - 38 por ciento), seguido de duodeno, yeyuno e íleon. El 40 por ciento de los casos son sintomáticos y es más frecuente su presentación en varones en torno a la 5ª y 6ª década de la vida. Objetivo: Presentar un caso de páncreas ectópico diagnosticado a través de un estudio histológico tras realizada la cirugía. Presentación de caso: Presentamos el caso de una paciente compatible con hipoglucemia y cuyo estudio definitivo mostró la presencia de tejido pancreático ectópico en estómago, con resolución completa de los síntomas tras tratamiento quirúrgico. La anatomía patológica mostró una lesión nodular tumoral benigna (2,5 cm), constituida por tejido pancreático heterotópico, con presencia de páncreas exocrino con acinos. Páncreas endocrino con presencia de islotes de Langerhans y componente epitelial con ductos. Afectación desde la submucosa hasta la subserosa, con una pared muscular propia con hiperplasia muscular en relación a la heterotopía pancreática. La mucosa gástrica mostraba inflamación crónica leve con escasos folículos linfoides. Conclusiones: La presencia de páncreas ectópico es una entidad poco frecuente, pero a tener en cuenta en pacientes con clínica de hipoglucemia, una vez descartadas otras causas. No existe consenso con respecto a indicaciones en el manejo de lesiones pequeñas y asintomáticas, por lo que se recomienda individualizar cada caso teniendo en cuenta el tamaño, la localización y el tipo histológico(AU)

Introduction: Ectopic pancreas is the second most frequent congenital anomaly after pancreas divisum. It was described for the first time in 1729 by Schultz and it is defined as the presence of pancreatic tissue with no anatomical or vascular communication with the main body of pancreas. The most common location is in the stomach (25-38 percent), followed by the duodenum, jejunum and ileum ones. 40 percent of the cases are symptomatic and is more frequent their presentation in males in the fifth or sixth decade of life. Objective: To present a case of ectopic pancreas diagnosed through a histological study after surgery. Case presentation: Case of a patient with clinical features compatible with hypoglycemia that after being studied showed the presence of ectopic pancreatic tissue in the stomach, with a complete solution of the symptoms after surgical treatment. The pathological anatomy showed a benign tumor nodular lesion (2.5 cm), made up of heterotopic pancreatic tissue, with the presence of exocrine pancreas with acini. Endocrine pancreas with the presence of islets of Langerhans and epithelial component with ducts. Involvement from the submucosa to the subserosa, with a proper muscular wall with muscular hyperplasia in relation to pancreatic heterotopia. The gastric mucosa showed mild chronic inflammation with few lymphoid follicles. Conclusions: The presence of ectopic pancreas is a rare condition, but it should be taken into account in patients with clinical features of hypoglycemia once ruled out other causes. There is no consensus in regards to the indications for the management of small and asymptomatic lesions, so, it is recommended to individualize each case taking into account the size, location and histological type(AU)

Páncreas ectópico en antro gástrico asociado a síntomas de reflujo. Reporte de un caso / Ectopic pancreas in gastric antrum associated to reflux symptoms. Report of a case

RESUMEN El páncreas ectópico es una entidad poco común. Como tumor submucoso de origen congénito, frecuentemente presenta un curso asintomático, aunque con posibles complicaciones. Su diagnóstico de certeza se basa en la endoscopia, el ultrasonido endoscópico y la histología, que permiten adoptar una conducta expectante o quirúrgica. El paciente estudiado presentó un páncreas ectópico localizado en antro gástrico asociado a síntomas de reflujo gastroesofágico rebeldes a tratamiento, los cuales motivaron el estudio endoscópico, con el consecuente hallazgo de dicha entidad (AU).

ABSTRACT Ectopic pancreas is a little common entity. As congenital-originated sub mucous tumor, it frequently presents an asymptomatic course, though with possible complications. Its definitive diagnosis is based in the endoscopy, endoscopic ultrasound and histology, allowing to adopt an expectant or surgical behavior. The current patient presented an unresponsive-to-treatment ectopic pancreas located in the gastric antrum associated to gastro-esophageal reflux symptoms. This motivated the endoscopic study consequently leading to finding this entity (AU).

Páncreas ectópico, diagnóstico diferencial de lesión gástrica subepitelial: reporte de caso y enfrentamiento inicial / Ectopic pancreas, differential diagnosis of subepithelial gastric lesion: case report and initial confrontation

Subepithelial lesions are generally an incidental diagnosis with an prevalence of 0.4%. These tumors represent a great diagnostic challenge, mainly when ruling out potentially malignant lesions, such as gastrointestinal stromal tumor (GIST), lymphomas and carcinomas. Among the many differential diagnosis, the ectopic pancreas arises with an prevalence of 1-2% in general population. The first diagnostic approach is performed using upper digestive endoscopy, computed tomography and endosonography. This last one has a diagnostic performance of less than 50%, which increases to 90% when it is associated with a histopathological examination. There is no current consensus regarding the management and monitoring of these lesions. Based on the imaging and histological characteristics, the possibilities range from observation to endoscopic or surgical resection. In this context, we will present a clinical case of ectopic pancreas as an incidental finding, and afterwards the diagnostic and therapeutic breakdown of subepithelial lesions.

Las lesiones subepiteliales son pesquisadas generalmente de manera incidental, con una prevalencia de 0,4%. Estos tumores suponen un gran desafío diagnóstico, principalmente al momento de descartar lesiones potencialmente malignas, como el tumor estromal gastrointestinal (GIST), linfomas y carcinomas. Dentro de los posibles diagnósticos, surge el páncreas ectópico, con una prevalencia de hasta 1-2% en la población general. La primera aproximación diagnóstica se realiza mediante endoscopia digestiva alta, tomografía computarizada y la endosonografía, ésta última con un rendimiento diagnóstico menor del 50%, que aumenta hasta el 90% al asociar el examen histopatológico. No existe consenso actual respecto al manejo y seguimiento de estas lesiones, que según sus características imagenológicas e histológicas, va desde la observación hasta la resección endoscópica o quirúrgica. En este contexto, se presenta un caso clínico de páncreas ectópico como hallazgo incidental y el desglose diagnóstico y terapéutico de las lesiones subepiteliales.

Infrecuente complicación de páncreas ectópico: obstrucción intestinal por pseudoquiste pancreático en píloro / Infrequent complication of heterotopic pancreas: intestinal obstruction by pancreatic pseudocyst in pylorus

Resumen: Presentamos un caso un hombre de 53 años con antecedentes de reflujo gastroesofágico y pirosis con varias visitas al servicio de urgencias por vómitos, con antecedentes de consumo crónico de alcohol. La TC sin y con contraste endovenoso mostró a nivel del píloro una lesion ovoidea de paredes gruesas con captación similar al tejido pancreático, con un gran componente quístico bien delimitado que condiciona una obstrucción intestinal. La ecografía confirma la presencia de una lesión quística con ecos móviles en su interior. Tras la realización de antrectomía, el estudio histológico revela un pseudoquiste pancreático sobre páncreas ectópico, siendo esta presentación muy infrecuente, con pocos casos descritos hasta la fecha. Conclusión: Los hallazgos clínico-radiológicos con TC y US de páncreas ectópico pueden orientar el diagnóstico, aunque no son concluyentes. El diagnóstico definitivo se realiza mediante estudio histológico.

Abstract: A 53 year-old male with a past history of chronic alcohol intake, presents with an intestinal obstruction. A CT scan shows an ovoid tumor in pylorus with a great cystic component, thick wall and delimited rim, causing gastric retention. Its walls have similar enhancing pattern as the pancreatic tissue. Ultrasound revealed the presence of a cystic tumor with mobile echoes inside. After antrectomy the histological study reports pancreatic pseudocyst hosted in ectopic pancreas. This is an unusual presentation and only a few cases have been reported. Conclusion: The clinical and radiographic findings of ectopic pancreas are non-specific. Definitive diagnostic requires histological study.

CT features of ectopic pancreas in gastrointestinal tract and its correlations with the pathology / 实用放射学杂志

Objective To explore CT features of ectopic pancreas in the gastrointestinal tract,and to compare and analyze with the pathological findings.Methods The clinical data of 20 cases with ectopic pancreas in gastrointestinal tract proved by surgery pathology or endoscopic biopsy were analyzed retrospectively,and the characteristics were summarized.Results Ectopic pancreas in gastrointestinal tract-20 single lesions,4 cases at lesser curvature of gastric body,7 cases at greater curvature of gastric antrum,6 cases at lesser curvature of gastric antrum,1 case at gastric angle and 2 cases at duodenum.The longest diameter of ectopic pancreas was from 0.8 to 3.5 cm,while the shortest one was from 0.6 to 2.5 cm.The axis of the lesions was parallel to the wall of the gastrointestinal tract. For 1 8 ectopic pancreas in gastrointestinal tract,1 6 were ovoid or round in shape,and the other 2 were slight lobulated.2 lesions in duodenum were ovoid in shape.1 2 lesions'margins were well-defined and ill-defined in other 8.Plain CT showed the ectopic pancreas with homogeneous density,1 8 lesions with endoluminal growth and exophytic growth of other 2 cases.The cystic change was also found in 2 cases.Enhanced CT showed 2 lesions with significant homogeneous enhancement,mainly composed of pancreatic acini in pathology;14 with medium enhancement close to the normal pancreas,composed by pancreatic acini,islet and ducts,and 2 with slight enhancement,composed with mature differentiated mucous glands with ducts.Two lesions'center cystic change areas show no enhancement result.Conclusion The CT features,such as direction of its organic axis,endoluminal growth and enhancement patterns have its useful characteristics.Different enhanced patterns of ectopic pancreas in gastrointestinal tract are related with the pathologic change.

A Rare Case of Early Gastric Cancer Combined with Underlying Heterotopic Pancreas

Heterotopic pancreas in the stomach is usually asymptomatic and benign. Here, we presented a rare case of an early gastric cancer overlying a heterotopic pancreas. A 48-year-old woman underwent esophagogastroduodenoscopy, which revealed a subepithelial mass measuring 2.0×1.5 cm on the gastric antrum with a 1-cm erosive erythematous discoloration on the surface. A biopsy specimen showed moderately differentiated tubular adenocarcinoma. Endosonography showed a heterogeneous hypoechoic mass measuring 1.3×0.6 cm, with indistinct margins in the second and third layers of the gastric wall; anechoic tubular structures within the mass were suggestive of heterotopic pancreas. Distal gastrectomy was performed, which confirmed an early gastric cancer confined to the mucosa, and a separate underlying heterotopic pancreas. Although heterotopic pancreas is most likely benign, careful endoscopic observation of the mucosal surface is necessary to avoid overlooking a coincident early gastric cancer.

One case of gastric duplication cyst with ectopic pancreas in adults / 中南大学学报(医学版)

Gastric duplication cyst is a very rare gastrointestinal tract malformation that accounts for 2％-4％ of alimentary tract duplications.It is a diagnostic dilemma for doctors because its clinical and radiological manifest is usually nonspecific.At the present stage,it can only rely on surgery.We should pay attention to ectopic pancreas resection and ligation of pancreatic duct during operation.There was one case of gastric duplication cyst with ectopic pancreas in adults from the Second Affdiated Hospital of Nanchang University.

Clinical observation of endoscopic submucosal dissection for uppergastrointestinal ectopic pancreas (36 cases) / 中国内镜杂志

Objective To evaluate the feasibility, efficacy, and safty of endoscopic submucosal dissection (ESD) in treatment of uppergastrointestinal ectopic pancreas. Methods 36 uppergastrointestinal ectopic pancreas were treated with ESD from January 1 2012 to November 30 2014. The definitive histological diagnosis of ectopic pancreas was made after the endoscopic treatment. We analyzed the operation method, dissected tissue, complication, retrospec-tively. Results 34 cases were located in stomach, the other 2 in duodenum. All cases underwent ESD, the mean op-erating time was 66 min. The mean dissected tissue diameter was 21 mm × 16 mm in the 36 cases. The curative re-section rate was 100.00 %. Bleeding rate of ESD was 2.77 %(1/36). Perferation rate of ESD was 2.77 %(1/36). 2 cases suffered from low grade fever. None need surgical intervention. Recurrence rate was 0.00%. Conclusions ESD is a minimally invasive technique that allows resection of whole lesions and provides precise histological information, which is particularly suitable for uppergastrointestinal ectopic pancreas.

Acute Ectopic Pancreatitis Occurring after Endoscopic Biopsy in a Gastric Ectopic Pancreas

Ectopic pancreas is a congenital anomaly and the most common type of ectopic tissue in the gastrointestinal tract. Most patients with an ectopic pancreas are asymptomatic and rarely have complications. Ectopic pancreatitis after an endoscopic biopsy has not been reported. We report a patient who developed acute ectopic pancreatitis in the stomach after an endoscopic biopsy. A 71-year-old male patient presented with a subepithelial tumor (SET) in the stomach and had no symptoms. Endoscopic ultrasonography demonstrated a 30-mm hypoechoic mural mass, lobulated margins, and anechoic duct-like lesions. To obtain proper tissue specimen, endoscopic biopsy was performed through the opening on the surface of the mass. The pathologic results confirmed an ectopic pancreas. One day after the endoscopic biopsy, he developed persistent epigastric pain. His serum amylase and lipase elevated. Computed tomography of the abdomen showed swelling of the SET and diffuse edema of the gastric wall. His condition was diagnosed as acute ectopic pancreatitis occurring after endoscopic biopsy.

Analysis on endoscopic submucosal dissection and submucosal tunneling endoscopic resection for gastric ectopic pancreas / 中国医师进修杂志

Objective To investigate the value of endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) for the diagnosis and therapy of gastric ectopic pancreas.Methods A total of 86 patients who were suspicion diagnose with gastric ectopic pancreas received ESD or STER in hospital,and the therapeutic effect and safety were followed-up.Results Fifty-four gastric ectopic pancreas patients were definitely diagnosed by postoperative pathology.Of the 54 patients,43 cases were located at the gastric antrum,7 cases were located at gastric fundus and gastric corpus juncture,4 cases were located at gastric corpus.Forty-five cases received ESD,9 cases received STER,rate of completely resection was 88.9％ (48/54),6 cases had a little tissue residual after resection.One case (1.9％,1/54) happened postoperative delay-bleeding,intraoperative and postoperative perforation was not found.During 1-32 months followed up,recurrence was not found.Conclusion ESD could excise the whole lesion to offer an accurate pathology diagnose,meanwhile good for treatment,ESD is an effective and relatively safe method for gastric ectopic pancreas,STER may be a new approach for gastric ectopic pancreas.

CT features of heterotopic pancreas and its correlation with pathologic changes / 实用放射学杂志

Objective To analyze the CT findings of heterotopic pancreas and the correlation with pathologic changes.Methods CT findings in 1 9 patients with heterotopic pancreas proven by surgery were reviewed retrospectively,14 of whom were scanned with enhanced CT.The correlation of CT findings and pathologic results were also analyzed.Results All patients had a single lesion with sized range from 0.8 to 4.7 cm and mean diameter of (2.2±0.6)cm.All lesions with homogeneous density were showed on plain scans including 7 lesions in stomach,8 in duodenum,2 in jejunum,1 in ileum and 1 beside the cardiac lymph nodes.The border of the lesions in 5 was unclear with exudative changes,mimicking acute pancreatitis.A sign of central umbilical concave was found in 2.Pathological results confirmed 14 lesions in submucosa,3 in muscular layer,1 in serosal layer and 1 in abdominal cavity.Hetero-topic pancreas presented early obvious enhancement in 9,mimicking normal pancreas,which was composed chiefly of pancreatic aci-ni.The enhanced degree of 4 lesions was lower than normal pancreas,which were composed of pancreas ductal epithelium and few pancreatic acini.No significantly enhancement was seen in 1,mimicing liomyoma,which was composed chiefly of pancreas ductal epithelium and smooth muscle hyperplasia.Conclusion Heterotopic pancreas in most cases presents characteristic submucosal disea-ses-like pattern,and different enhanced patterns of heterotopic pancreas are related with the pathologic changes.

How Should the Pyloric Submucosal Mass Coexisting with Hypertrophic Pyloric Stenosis Be Treated?: A Case of Pyloric Ectopic Pancreas with Hypertrophic Pyloric Stenosis / 대한소아소화기영양학회지

Co-existing pyloric submucosal masses with hypertrophic pyloric stenosis (HPS) are very rare and treating these lesions is always a problem. A 20-day-old boy presented with recurrent episodes of projectile non-bilious vomiting lasting for 5 days. HPS was suspected due to the presenting age and the symptoms. The sonography demonstrated not only circumferential wall thickening of the pylorus, but also a pyloric submucosal mass. At laparotomy, a 0.8 cm sized pyloric submucosal mass was identified along with a hypertrophied pylorus. Pyloric excision was performed due to the possibility of sustaining the symptoms and malignancy. The pathological report of the submucosal mass was ectopic pancreas. Coexisting pyloric lesions can be diagnosed along with HPS, and surgical excision, not just pyloromyotomy, should be considered in these circumstances. To the best of our knowledge, this is the first case report of pyloric ectopic pancreas and HPS to be diagnosed concurrently.

Heterotopia pancreática yeyuna yuxtahepática y en quiste de conducto colédoco / Jejunal juxtahepatic and common bile duct (ductus choledochus) cystic pancreatic heterotopia

Se exponen 3 casos con hallazgo incidental de páncreas heterotópico, en autopsia y 2 piezas quirúrgicas para hacer una breve revisión del tema. Casos: 1. Mujer de 53 años de edad fallecida por neumonía de focos múltiples. Durante el estudio post mortem se encontró, a nivel del segmento yeyunal, un nódulo constituido histológicamente por múltiples conductos con epitelio columnar y fibras anchas desorganizadas de músculo liso. 2. Preescolar varón de 2 años 11 meses de edad con diagnóstico de quiste de colédoco y resección del mismo. En uno de los cortes de pared se observó una banda de tejido que a la microscopía de luz correspondía a tejido pancreático sin alteraciones. 3. Escolar mujer de 6 años 10 meses de edad con diagnóstico de síndrome de Byler candidata a transplante hepático. Los cortes histológicos del explante en la región del hilio revelaron grupos multifocales de conductos y acinos pancreáticos sin presencia de islotes. Conclusión: La heterotopia pancreática es un hallazgo infrecuente que se puede observar a cualquier nivel del tracto gastrointestinal e inclusive fuera del mismo, por lo que la caracterización histopatológica de esta alteración permite distinguirla de otras lesiones. Pese a su conducta habitualmente benigna y asintomática, ocasionalmente puede dar origen a cuadros obstructivos, hemorrágicos, inflamatorios o neoplásicos.

We report three cases of pancreatic heterotopia incidentally found (one in autopsy and two in surgical pieces) with a brief review of the literature. Cases: 1. A fifty-three-year-old woman who died of bronchopneumonia. During post-mortem examination, a nodule (hystologically formed by multiple ducts lined by columnar epithelium and broad disarranged smooth muscle fibers) was found at the level of jejune. 2. 5-year, 11-month-old male with diagnosis ofcholedochal cyst. In the resected specimen, one of the mural slices showed a tissue stripe that under light-microscope examination corresponded to normal pancreatic tissue. 3. 6-year, 10-month-old female diagnosed with Byler syndrome who was recipient of liver transplant. Slices taken from the hilum in the resected specimen revealed multiple clusters of pancreatic acini and ducts without evidence of endocrine islets. Conclusion: Pancreatic heterotopia is an uncommon finding, which may be found at any level of the gastrointestinal tract, and even outside it. Histopathologic studies allow to distinguish this disorder from other lesions. Despite its commonly benign and asymptomatic behaviour, it may sometimes produce obstruction, hemorrhage, inflammation or neoplasms.

Perilesional Steatosis in Ectopic Pancreas Mimicking Exogastric Mass : A Case Report

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.

Ectopic Pancreas Bleeding in the Jejunum Revealed by Capsule Endoscopy

Ectopic pancreas is defined as pancreatic tissue found outside the usual anatomic location. It is often found incidentally at different sites in the gastrointestinal (GI) tract. The incidence of ectopic pancreatic tissue in autopsy series is 1% to 2%, with 70% of the ectopic lesions found in the stomach, duodenum and jejunum. Although it is usually a silent anomaly, an ectopic pancreas may become clinically evident when complicated by inflammation, bleeding, obstruction or malignant transformation. We report a case of ectopic pancreas located in the jejunum and presenting as an obscure GI bleeding, which was diagnosed by capsule endoscopy.

Endoscopic ultrasonography features of gastric ectopic pancreas / 中华超声影像学杂志

Objective To describe the characteristic endoscopic ultrasonography (EUS) features of gastric ectopic pancreas.Methods Totally 23 patients were diagnosed pathologically as having gastric ectopic pancreas.The EUS images of the lesions were retrospectively reviewed regarding layer of origin,size,growth pattern,margin,and internal echo pattern.Results The coincidence of EUS and pathologic diagnosis was 91%(21/23).EUS revealed that the lesions originated from the second,third,and/or fourth layers of the gastric wall.Most lesions were heterogenous,mainly isoechoic.The borders of the lesions were indistinct in 70%(16/23) patients. Anechoic cystic or tubular structures within the lesions appeared in 10 of the 23 lesions(43%).The mean longest/shortest diameter ratio of ectopic pancreas was 1.7.Conclusions Characteristic EUS features of gastric ectopic pancreases include:mural lateral growth pattern,third layer (submucosa) origin,indistinct margin,intermediate echogenecity,anechoic areas,and fourth-layer thickening.Careful assessment of the EUS findings may be a useful aid in the diagnosis of gastric ectopic pancreas.

Pancreatite aguda necro-hemorrágica em pâncreas ectópico localizado no mesentério do colo ascendente: Um caso muito raro / Acute necrotic and hemorrhagic pancreatitis in ectopic pancreas located in the ascendent colon mesentery: A very rare case

O pâncreas ectópico é uma malformação congênita definida como o tecido pancreático sem continuidade com o pâncreas tópico normal, nem conexão com sua vascularização, apresentando ductos e vascularização independentes. As heterotopias pancreáticas descritas ocorrem mais frequentemente no interior do trato digestório proximal, principalmente no estômago, duodeno, próximo à papila de Vater, e jejuno. Descrevemos o caso de uma adolecente de 16 anos, com quadro abdominal doloroso progressivo há três dias que negava náusea,vômito e febre. Ao examefísico, abdome plano, flácido, doloroso à palpação profunda na região do flanco e do hipocôndrio direitos, com grande massa tumoral palpável nesta região, dolorosa e de pouca mobilidade. A ultrassonografia mostrou imagem de tumoração de aspecto misto, com 8 por 10 cm. A tomografia computadorizada helicoidal mostrou massa tumoral arredondada de aproximadamente 10 por 12 cm de diâmetro, encapsulada e adjacente à borda direita da veia cava inferior sem obstrução intestinal. No ato operatório foi identificado tumor arredondado, de aproximadamente 12 cmde diâmetro, anterior ao arco duodenal, medial ao lobo direito do fígado e vesícula biliar e no mesentério do colo ascendente. Embora raro e os exames radiológicos não definam o tipo de tumor existente, principalmente os localizados no mesentério, o pâncreas ectópico deve sempre ser incluído na elaboração do diagnóstico diferencial dasmassas tumorais abdominais, principalmente aquelas extraluminais.

Ectopic pancreas is a congenital malformation defined as pancreatic tissue that has no continuity with the normal topic pancreas or connection with its vascularization, but presents independent ducts and vascularization. Pancreas heterotopias occur most frequently in the interior of the proximal digestive tract, particularly in the stomach, duodenum, next to the ampulla of Vater and jejune. We describe the case of a 16 year-old girl presenting a three-day progressive painful abdominal condition with no nausea, vomit or fever. Physical exam showed a flat flaccid abdomen, painful when deeply palpated at the right flank and right hypochondrium area where a large palpable low mobility tumoral mass was located. Ultrasonography showed an image of a tumor with mixed aspect measuring 8 by10 cm. Helicoidal computerized tomography revealed a round-shaped tumoral mass of approximately 10 by 12 cm in diameter, encapsulated and adjacent to the right edge of the inferior cava vein, but not causing intestinal obstruction. At surgery, a round tumorwas identified with a diameter of approximately 12 cm, located at the anterior duodenal arch, medially to the liver right lobe and gall bladder and in the ascendant colon mesentery. Despite its rarity, and given that radiological exams do not define the type of an existing tumor especially those located in the mesentery, ectopic pancreas should always beconsidered in the elaboration of abdominal tumoral masses, particularly extra-luminal tumors.

Diagnosis and treatment of heterotopic pancreas in gastrointestinal tract: A report of 60 cases / 中华胰腺病杂志

Objective To investigate the clinical features, diagnosis and treatment of heterotopic pancreas in gastrointestinal tract. Methods A total of 60 cases of heterotopic pancreas in gastrointestinal tract diagnosed through endoscopic ultrasonography and pathological examination were treated in our hospital in the recent 10 years. Their data were retrospectively analyzed. Results Among all the 60 patients, the lesions were located in duodenal bulb cavity in 3 cases, in duodenal descendent in 2 cases, in gastric angle in 3 cases,in the junction of gastric antrum and corpus ventriculi in 2 cases and in gastric antrum in 50 cases. All of the 60 patients were definitely diagnosed through endoscopy, endoscopic ultrasonography and pathological examination. 28 patients were treated by endoscopic high-frequency electronic resection, 2 patients were treated by endoscopic mucosal resection (EMR), 30 patients were treated by surgical operation; no operative complication was found, and satisfactory clinical effects had been observed in these patients. Conclusions Endoscopic ultrasonography has great value in the diagnosis and endoscopic therapy of heterotopic pancreas in gastrointestinal tract. It can provide the guide for the choice of treatment. Minimally invasive endoscopic treatment is safe and effective for heterotopic pancreas and has great clinical value.

CT Findings of an Ectopic Pancreas in the Anterior Mediastinum

We report here on a rare case of an ectopic pancreatic tissue in the anterior mediastinum. A 32-year-old woman without any symptoms was transferred to our hospital because of an abnormal large mediastinal shadow on her chest radiograph during a checkup. The computed tomography (CT) scan revealed a giant cystic-solid mass that measured 16 x 13 x 8 cm and it was located in the center of the anterior mediastinum and it symmetrically grew to two sides. On enhanced CT scans, the solid component of the mass showed marked enhancement. We performed total surgical resection of the mass and complete pancreatic tissues were verified on the pathological examination.