Heterotopic Pancreas in the Stomach Wall – A Rare Histological Diagnosis of Submucous Lesson – Casuistic Report


Authors: T. Toporcer 1;  L. Lakyová 1;  P. Baník 2;  J. Radoňak 1
Authors‘ workplace: I. chirurgická klinika, Lekárska fakulta UPJŠ a UNLP, Košice, Slovenská republika 1;  Oddelenie patológie, UNLP, Košice, Slovenská republika 2
Published in: Rozhl. Chir., 2011, roč. 90, č. 9, s. 504-507.
Category: Monothematic special - Original

Overview

Heterotopic pancreas (HP) is defraed as abnormally localized pancreatic tissue without any anatomical and vascular connection with pancreas. Incidence of HP is 0.2–0.5% of patients underwent upper medial laparotomy. The most common symptoms of HP are abdominal discomfort and pain, upper gastrointestinal bleeding and intermittent bowel obstruction. Gastroscopy is the most commonly used first diagnostic procedure. Ultrasound evaluation, computer tomography and namely endoscopic ultrasound evaluation are useful imaging procedures of HP.

Casuistic report of patient with upper gastrointestinal bleeding is presented. Imaging procedures have recorded stomach tumor 3cm in diameter in back wall of stomach. Billroth II resection of stomach was performed. Histological evaluation of removed part of stomach recorded heterotopic pancreas type 1 of Heinrich classification.

HP diagnosis before surgery is difficult because of submucous localization of lesion. Fine needle biopsy during gastroscopy is one of diagnostic possibilities without surgery. Endoscopic excision of lesion is possible if histological evaluation by fine needle biopsy is successful and anatomical localization is appropriate. The most of patients need surgical excision of HP. Peroperative histological evaluation allows a minimalization of excision area. Opinions of asymptomatic HP treatment are ambiguous. The most of published papers recommend excision of asymptomatic HP also, because of risk of next complications.

Key words:
heterotopic pancreas – endoscopy – upper gestrointestinal bleeding


Sources

1. Jiang, L. X., Xu, J., Wang, X. W., et al. Gastric outlet obstruction caused by heterotopic pancreas: A case report and a quick review. World J. Gastroenterol., 2008, roč. 14, s. 6757–6759.

2. Yuan, Z., Chen, J., Zheng, Q., et al. Heterotopic pancreas in the gastrointestinal tract. World J. Gastroenterol., 2009, roč. 15, s. 3701–3703.

3. Agale, S. V., Agale, V. G., Zode, R. R., et al. Heterotopic pancreas involving stomach and duodenum. The Journal of the Association of Physicians of India, 2009, roč. 57, s. 653–654.

4. Gokhale, U. A., Nanda, A., Pillai, R., et al. Heterotopic pancreas in the stomach: a case report and a brief review of the literature. Jop, 2010, roč. 11, s. 255–257.

5. Klob, J. Pancreas accessorium. Zeitschrift der Kaiserl Konigl Gesellschaft der Aerzte zu Wien, 1859, roč. 15, s. 732.

6. Mayes, R., Mainie, I., Davis, R., et al. Pancreatic heterotopia presenting as a gastric submucosal lesion. The Ulster medical journal, 2010, roč. 79, s. 100–103.

7. Song, D. E., Kwon, Y., Kim, K. R., et al. Adenocarcinoma arising in gastric heterotopic pancreas: A case report. K. Korean Med. Sci., 2004, roč. 19, s. 145–148.

8. Mizrak, D., Bektas, M., Kaygusuz, G., et al. Gastric aberrant pancreas. Turk. J. Gastroenterol., 2010, roč. 21, s. 68–69.

9. Christodoulidis, G., Zacharoulis, D., Barbanis, S., et al. Heterotopic pancreas in the stomach: a case report and literature review. World J. Gastroenterol., 2007, roč. 13, s. 6098–6100.

10. Gurocak, B., Gokturk, H. S., Kayacetin, S., et al. A rare case of heterotopic pancreas in the stomach which caused closed perforation. The Netherlands journal of medicine, 2009, roč. 67, s. 285–287.

11. Seneviratne, S. A., Ramanayaka, I. T., Samarasekera, D. N. Heterotopic pancreas in the body of the stomach. The Ceylon medical journal, 2009, roč. 54, s. 57–58.

12. Osanai, M., Miyokawa, N., Tamaki, T., et al. Adenocarcinoma arising in gastric heterotopic pancreas: clinicopathological and immunohistochemical study with genetic analysis of a case. Pathology international, 2001, roč. 51, s. 549–554.

13. Chak, A., Canto, M. I., Rosch, T., et al. Endosonographic differentiation of benign and malignant stromal cell tumors. Gastrointestinal endoscopy, 1997, roč. 45, s. 468–473.

14. Gaspar Fuentes, A., Campos Tarrech, J. M., Fernandez Burgui, J. L., et al. [Pancreatic ectopias]. Revista espanola de las enfermedades del aparato digestivo, 1973, roč. 39, s. 255–268.

15. Khashab, M. A., Cummings, O. W., DeWitt, J. M. Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas. World J. Gastroenterol., 2009, roč. 15, s. 2805–2808.

16. Kaťuchova, J., Bober, J., Zavacky, P., et al. Kvalita života pacientov po resekčných výkonoch pre chronickú pankreatitídu. Rozhl. Chir., 2008, roč. 87, s. 207–212.

17. Krška, Z., Šváb, J. [Fulminant acute pancreatitis]. Rozhl. Chir., 2009, roč. 88, s. 563–567.

18. Emerson, L., Layfield, L. J., Rohr, L. R., et al. Adenocarcinoma arising in association with gastric heterotopic pancreas: A case report and review of the literature. Journal of surgical oncology, 2004, roč. 87, s. 53–57.

19. Kaťuchová, J., Bober, J., Zavacky, P. Chronická pankreatitída, indikácie k resekčným výkonom a pooperačné komplikácie. Rozhl. Chir., 2008, roč. 87, s. 200–206.

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Surgery Orthopaedics Trauma surgery
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