Ectopic pancreas
Intrahepatic
peribiliary perivascular epithelioid cell tumor (PEComa) associated with heterotopic pancreas: A case report. Radiological and macroscopic features of the bile duct and liver tumor. a Magnetic resonance cholangiopancreatography (MRCP). The B2 bile duct is obstructed (arrow) and dilated at its periphery (arrow heads). b Curved multiplanar reconstruction image of contrast-enhanced CT. The liver tumor is visualized as a high-intensity area in the arterial phase (arrow). c Macroscopic view of the tumor. Grayish tumor tissue is observed (arrow)
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–c Heterotopic pancreas in a 48-year-old female. Axial contrast-enhanced CT images obtained during the plain (a) /arterial (b) /venous (c) phase showed a flat mass (white arrows) in the gastric cardia, with a tendency to grow horizontally. d–f Gastrointestinal leiomyoma in a 42-year-old male. Axial contrast-enhanced CT images also demonstrated a same flat mass (white arrows) in the gastric cardia, but with a vertical growth tendency compared to the horizontal axis. g–i Gastrointestinal leiomyoma in a 48-year-old female. Axial contrast-enhanced CT images also revealed a vertically growing and round mass (white arrows) in the gastric cardia
Clinical
impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment?. Heinrich’s classification of pancreatic heterotopia
Clinical
impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment?. Computed tomography (CT) scans (a/b) of a duodenal pancreatic heterotopia (arrows) with a duodenal stenosis
Adenocarcinoma
arising from an ectopic pancreas in the duodenum: a case report. Enhanced multi-detector row computed tomography (MDCT) image showing the wall thickness in the duodenum in the transverse (a) and the coronal (b) planes. Arrow heads: wall thickness of the first part of the duodenum
Ectopic
pancreas tissue appearing in a mediastinal cyst. Chest CT -The arrows show the residual cystic mass detected between the right hilum and the ascending aorta connecting to the pericardium, the superior vena cava and the aorta on chest CT (A,B).
Ectopic
pancreatic tissue • Ectopic pancreatic tissue - Ganzer Fall bei Radiopaedia
Ectopic
pancreatic tissue • Ectopic pancreas - Ganzer Fall bei Radiopaedia
Ectopic
pancreatic tissue • Ectopic pancreatic tissue - Ganzer Fall bei Radiopaedia
Ectopic
pancreatic tissue • Ectopic pancreatic tissue - Ganzer Fall bei Radiopaedia
Clinical
picture: multiple sites of ectopic pancreatic tissue. a Aberrant pancreatic tissue of the stomach with duct and b suspected neuro-endocrine tumour, which was a second site of ectopic pancreatic tissue upon analysis.
Enteric
duplication cysts in children: varied presentations, varied imaging findings. A 3-week-old term newborn with abdominal distention and gastric intolerance. a Longitudinal US view of the right low quadrant: thickened wall (stars) cystic lesion next to a bowel loop (dashed-line arrow). The “Y” sign between the bowel and the lesion (arrow). b Power Doppler US demonstrates the significant vascularisation in the cyst wall. c Surgical findings: a cystic tumour next to the ileocecal valve. Pathological findings: ileal duplication cyst with heterotopic pancreatic tissue
Heterotopic
pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature. Magnetic resonance imaging of gastro-pyloric heterotopic pancreas (circle)
A case report
of ectopic pancreatitis in an isolated enteric duplication cyst. Enhanced CT. a In the ileal mesentery at the level of the umbilicus, a cystic lesion with enhancing wall is seen (arrows). There is a enhancing nodule in the cystic wall (arrow heads). b On coronal plane, the lesion appears to be a tubular structure. The fat density around the lesion is increased suggesting inflammation (arrows)
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–h Non-contrast axial T1-weighted (a), pre-contrast axial T1-weighted (b), post-contrast axial T1-weighted (c, d), and post-contrast coronal T1-weighted (h) images showed a lesion within the duodenum (white arrows) demonstrating T1-weighted hyperintense or isointense signal like those of the normal pancreas. This tissue showed similar imaging characteristics of the normal pancreas on axial T2-weighted (e) and coronal true fast image with steady-state precession (True-FISP) (f) images (white arrows). Magnetic resonance cholangiopancreatography image (g) showed a nodular filling defect in the duodenum
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–c Axial plain (a) /arterial (b) /venous (c) phases CT images of a heterotopic pancreas in the duodenum of a 57-year-old female showed a 1.2 cm, round, well-defined, and mixed-growing lesion (white arrows). Small duct-like structure (black arrows) was vaguely seen within the lesion in each phase, presenting slightly hypo density compared to the surroundings. d–f Axial arterial (d) /Venous (e) /coronal venous (f) phases CT images of a heterotopic pancreas in the duodenum of a 58-year-old male showed a 1.3 cm × 0.9 cm, flat lesion (white arrows) with a lobulated contour and an exophytic growth pattern. Small duct-like structure (black arrows) was seen within the lesion in each phase
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a, b Coronal and axial enhanced CT images of a heterotopic pancreas in the duodenum of a 53-year-old male showed a 1.3 cm × 0.9 cm, endoluminal lesion (white arrows) with a lobulated margin, presenting round contour on axial image while flat pattern on coronal CT image. Small duct-like structure (black arrow) was seen within the lesion, which measured with a long diameter to short diameter > 1.4 on coronal CT image. c, d Axial enhanced CT images of a heterotopic pancreas in the gastric antrum of a 58-year-old male showed a 1.2 cm × 0.8 cm, oval, ill-defined, and endoluminal lesion (white arrows), with a long diameter to short diameter > 1.4
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Images demonstrating the gastric body with a submucosa heterotopic pancreas (white arrows) identified within the wall of the stomach. a, b Contrast-enhanced axial CT images in arterial and venous phases. c, d Upper endoscopy images. e, f Endoscopic ultrasonography images
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. A 15-year-old female presented with abdominal pain and distension underwent various imaging examinations. a Single spot image of the upper gastrointestinal tract on a barium fluoroscopic study demonstrated an intraluminal filling defect within the duodenum with a central indentation (white arrow) consistent with heterotopic pancreas. b Endoscopy showed a subepithelial lesion (white arrow) along the first portion of the duodenum with surrounding duodenitis. c–d Contrast-enhanced axial CT images revealed a hyper-enhanced lesion (white arrows) with ill-defined margin and thickening of the surrounding duodenal wall. e–h Non-contrast axial T2-weighted (e), pre-contrast T1-weighted (f), post-contrast arterial T1-weighted (g), and post-contrast venous T1-weighted images (h) showed a lesion within the first portion of the duodenum (white arrows) demonstrating T2-weighted slightly hyperintense signal, pre-contrast T1-weighted slightly hypointense signal, and post-contrast T1-weighted isointense like those of the normal pancreas
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Groove pancreatitis in a 44-year-old male. a–f Axial contrast-enhanced CT images showed a sheetlike hypoattenuating mass (black arrows) in the pancreaticoduodenal groove and separated from the pancreatic head and the duodenum, with thickening of adjacent medial wall of the duodenum. a–c The final pathology demonstrated a 2.7 cm sized heterotopic pancreas in the duodenum (white arrows)
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–d A 46-year-old female presented with abdominal pain and anorexia over the course of one year with a weight loss. Contrast-enhanced axial CT images presented a 5.8 × 4.9 cm, endoluminal, and ill-defined mass (black arrows) in the duodenum accompanied by subsequent gastric outlet obstruction with surrounding inflammation and duodenal intussusception, and the patient was noted to have mild elevation in her amylase and lipase. The patient was subsequently taken to the operating room for antrectomy and Billroth II reconstruction. Her pathology demonstrated a heterotopic pancreas in the duodenum
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–d Axial plain/arterial/venous phases CT images of a 33-year-old female showed a 2.3 × 1.7 cm, round, and micro-lobulated subepithelial lesion (white arrows), indicating an endoluminal growth pattern of a heterotopic pancreas in the gastric body (a–c). d Coronal venous phase CT image
A case report
of ectopic pancreatitis in an isolated enteric duplication cyst. Follow-up CT. On the follow up CT at 3 months revealed, decrease in size of the lesion is seen. There is a enhancing nodule seen in the cystic wall (arrow)
A case report
of ectopic pancreatitis in an isolated enteric duplication cyst. Enhanced CT, retrospective finding. An independent blood vessel coursing through the dorsal side into the lesion was identified (arrows)
Insight into
gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. a–c Heterotopic pancreas in a 61-year-old female. Axial contrast-enhanced CT images obtained during the plain (a) /arterial (b) /venous (c) phases showed a heterogeneous enhanced flat mass (white arrows) in the gastric antrum. The mass had an endoluminal growth pattern, which is more common with heterotopic pancreatic lesion in the stomach. d–f Gastrointestinal stromal tumor in a 41-year-old male. Axial contrast-enhanced CT images obtained during the plain (d) /arterial (e) /venous (f) phases also showed a homogeneous enhancing round mass (white arrows) in the gastric antrum with the same endoluminal growth pattern
Ectopic pancreatic tissue, also known as heterotopic pancreatic tissue, refers to the presence of pancreatic tissue in the submucosal, muscularis or subserosal layers of the luminal gastrointestinal tract outside the normal confines of the pancreas and lacking any anatomic or vascular connection with the main pancreas.
Epidemiology
It is reportedly relatively common, affecting ~5% (range 1-10%) of people.
Clinical presentation
Most commonly an asymptomatic entity.
Pathology
Location
Recognized locations for ectopic pancreatic tissue include:
- proximal duodenum
- gastric antrum including within gastric duplication cysts
- proximal jejunum
- Meckel diverticulum
- ileum
If the ectopic pancreatic tissue is functional, it is subject to the same variation of pathology that affects the normal gland, including, but not limited to pancreatitis and pancreatic tumors.
Radiographic features
On upper gastrointestinal examination, an ectopic pancreas appears as an extramucosal, smooth, broad-based lesion either along the greater curvature of the gastric antrum or in the proximal duodenum.
Barium study
In 45% of the cases of ectopic pancreas discovered on upper gastrointestinal examination, the ectopic pancreatic tissue contains a central small collection of barium, i.e. a central niche or umbilication, indicative of the rudimentary duct’s draining orifice . It is this finding that is diagnostic of ectopic pancreatic tissue.
CT
Contrast enhanced CT may show a homogeneously enhancing tissue (similar to normal pancreas) or cystic area (acinar component or pseudocyst).
Treatment and prognosis
Laparoscopic wedge resection is usually successful in removing the ectopic tissue, although its success is dependent on the location.
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Assoziationen und Differentialdiagnosen zu Heterotopie des Pankreas:
