Heterotopic pancreas in the gallbladder:A case report

BACKGROUND Heterotopic pancreas(HP)refers to pancreatic tissue located in areas with no vascular or anatomical connection to the pancreas.HP occurs mostly in the stomach,duodenum,and colon,and rarely in the gallbladder.CASE SUMMARY A 57-year-old woman was referred to our hospital complaining of right upper quadrant discomfort for 3 years.An abdominal computed tomography scan revealed adenomyomatosis with a thickened fundus of the gallbladder.The patient underwent a laparoscopic cholecystectomy,and pathological examination unexpectedly showed heterotopic pancreatic tissue in the gallbladder.The patient had a favorable recovery and was discharged on postoperative day 3.She did not report any symptoms or complications at the 6-mo postoperative follow-up.Pathologists should pay close attention to such pancreatic tissue and carefully examine it for dysplasia or malignancy.CONCLUSION This case provides more information about HP in the gallbladder,a rare occurrence.

Advances in the diagnosis and treatment of heterotopic pancreas

Heterotopic pancreas,a rare congenital malformation,manifests outside the normal pancreas.Research suggests that abnormal embryonic development is linked to the presence of heterotopic pancreas.Three prevailing theories explain its mechanism:Dislocation theory,metaplasia theory,and totipotent stem cell theory.Clinical presentations of heterotopic pancreas are often nonspecific,with most patients being asymptomatic and incidentally discovered during unrelated surgeries or examinations.Endoscopic ultrasound,computed tomography,and magnetic resonance imaging are commonly employed diagnostic tools for heterotopic pancreas.However,the accuracy of diagnosis based on these methods is not consistently high,necessitating histopathological confirmation in many cases.Treatment options for heterotopic pancreas typically involve endoscopic resection,surgical resection,or observation through follow-up.

Heterotopic mesenteric ossification caused by trauma:A case report

BACKGROUND Heterotopic mesenteric ossification(HMO)is a clinically rare condition characterized by the formation of bone tissue in the mesentery.The worldwide reporting of such cases is limited to just over 70 instances in the medical literature.The etiology of HMO remains unclear,but the disease is possibly induced by mechanical trauma,ischemia,or intra-left lower quadrant abdominal infection,leading to the differentiation of mesenchymal stem cells into osteoblasts.Here,we present a rare case of HMO that occurred in a 34-year-old male,who presented with left lower quadrant abdominal pain.CASE SUMMARY We report the case of a 34-year-old male patient who presented with left lower abdominal pain following trauma to the left lower abdomen.He subsequently underwent surgical treatment,and the postoperative pathological diagnosis was HMO.CONCLUSION We believe that although there is limited literature and research on HMO,when patients with a history of trauma or surgery to the left lower abdomen present with corresponding imaging findings,clinicians should be vigilant in distinguishing this condition and promptly selecting appropriate diagnostic and therapeutic interventions.

Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum

A 62-year-old Japanese man presented to our hospital with a history of weight loss of 6 kg in 4 mo. Imaging examinations revealed a tumor located on the third portion of the duodenum with stenosis. We suspected duodenal carcinoma and performed pancreas-preserving segmental duodenectomy. Adenocarcinoma arising from a heterotopic pancreas at the third portion of the duodenum was finally diagnosed by immunohistochemical staining. Malignant transformation in the duodenum arising from a heterotopic pancreas is extremely rare; to our knowledge, only 13 cases have been reported worldwide, including the present case. The most common location of malignancy is the proximal duodenum at the first and descending portion. Herein, we describe the first case of adenocarcinoma arising from a heterotopic pancreas, which was located in the third portion of the duodenum, with a review of the literature.

Misdiagnosis and Delayed Diagnosis for Ectopic and Heterotopic Pregnancies after In Vitro Fertilization and Embryo Transfer

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.

Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas

AIM:To improve the diagnosis of heterotopic pancreas by the use of contrastenhanced computed tomography(CT)imaging and CT virtual endoscopy(CTVE).METHODS:A total of six patients with heterotopic pancreas,as confirmed by clinical pathology and immunohistochemistry in the Sixth Affiliated People's Hospital of Shanghai Jiao Tong University,Shanghai,China,were included.Nonenhanced CT and enhanced CT scanning were performed,and the resulting images were reviewed and analyzed using threedimensional postprocessing software,including CTVE.RESULTS:Four males and two females were enrolled.Several heterotopic pancreas sites were involved;three occurred in the stomach,including the gastric antrum(n =2)and lesser curvature(n=1),and two were in the duodenal bulb.Only one case of heterotopic pancreas lesion occurred in the mesentery.Four cases had a solid yet soft tissue density that had a homogeneous pattern when viewed by enhanced CT.Additionally,their CT values were similar to that of the pancreas.The ducts of the heterotopic pancreas tissue,one of the characteristic CT features of heterotopic pancreas tissue,were detected in the CT images of two patients.CTVE images showed normal mucosa around the tissue,which is also an important indicator of a heterotopic pancreas.However,none of the CTVE images showed the typical signs of central dimpling or umbilication.CONCLUSION:CT,enhanced CT and CTVE techniques provide useful information about the location,growth pattern,vascularity,and condition of the gastrointestinal wall around heterotopic pancreatic tissue.

Acupuncture at heterotopic acupoints enhances jejunal motility in constipated and diarrheic rats

AIM: To investigate the effect and mechanism of acupuncture at heterotopic acupoints on jejunal motility, particularly in pathological conditions.

Ligation-assisted endoscopic mucosal resection of gastric heterotopic pancreas

Heterotopic pancreas is a congenital anomaly characterized by ectopic pancreatic tissue.Treatment of heterotopic pancreas may include expectant observation,endoscopic resection or surgery.The aim of this report was to describe the technique of ligation-assisted endoscopic mucosal resection(EMR) for resection of heterotopic pancreas of the stomach.Two patients(both female,mean age 32 years) were referred for management of gastric subepithelial tumors.Endoscopic ultrasound in both disclosed small hypoechoic masses in the mucosa and submucosa.Band ligation-assisted EMR was performed in both cases without complications.Pathology from the resected tumors revealed heterotopic pancreas arising from the submucosa.Margins were free of pancreatic tissue.Ligation-assisted EMR is technically feasible and may be considered for the endoscopic management of heterotopic pancreas.

Gastric outlet obstruction caused by heterotopic pancreas:A case report and a quick review

A 46-year-old Chinese woman presented with nausea, recurrent vomiting, and abdominal pain. Gastroduodenal endoscopic examination revealed an oval-shaped submucosal tumor at the prepyloric area on the posterior wall of the stomach. A degenerated gastrointestinal stromal tumor was suspected. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas （HPs） was confirmed. The patient had an uneventful postoperative course and was discharged 7 d a^er operation. The patient remains healthy and symptom-free in the follow-up of 6 mo. This is a report of a case of gastric outlet obstruction resulting from pancreatic heterotopia in the gastric antrum in an adult woman.

Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).

Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

Heterotopic pancreas(HP) is a relatively uncommon entity that is defined as pancreatic tissue without a true anatomical or vascular connection to the pancreas. HP does not cause symptoms in most cases but can occasionally produce various manifestations, including nausea, vomiting, abdominal pain, and even heterotopic pancreatitis. Here, we report an unusual case in which heterotopic pancreatitis complicated by the formation of a pseudocyst that caused gastric outlet obstruction was diagnosed based on serum hyperamylasemia and findings from endoscopic ultrasonography(EUS)-guided fine needle aspiration(EUS-FNA) cytology. EUS-guided single pigtail stent insertion was successfully performed for recurrent gastric outlet obstruction. The patient has remained healthy and symptom-free during 4 years of surveillance. In the context of the relevant literature, the described case is a rare case of HP complicated by a pseudocyst treated via EUS-FNA and stent insertion.

Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands

Herein, we present a case of gastric adenocarcinoma of fundic gland type(GA-FG) spreading to heterotopic gastric glands(HGG) in the submucosa. A 58-year-old man with epigastric pain was referred to our hospital and underwent an esophagogastroduodenoscopy. A Borrmann type II gastric cancer at the antrum and a 10 mm submucosal tumor-like lesion in the lesser curvature of the upper third of the stomach were detected. Histological examination of the biopsy specimens obtained from the submucosal tumorlike lesion suggested a GA-FG. Therefore, endoscopic submucosal dissection was performed as excisional biopsy, and histopathological examination of the resected specimen confirmed a GA-FG and HGG proximal to the GA-FG. Although the GA-FG invaded the submucosal layer slightly, the submucosal lesion of the GA-FG had a poor stromal reaction and was located just above the HGG in the submucosa. Therefore, wefinally diagnosed the lesion as a GA-FG invading the submucosal layer by spreading to HGG.

Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum:A case series and systematic literature review

BACKGROUND Heterotopic pancreas(HP)is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract.While the majority of heterotopic pancreatic lesions are asymptomatic,many manifest severe clinical symptoms which require surgical or endoscopic intervention.Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature.The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.AIM To classify the common clinical manifestations of heterotopic pancreas.METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018.Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location.Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated.These were compared to a systematic review of the literature utilizing Pub Med and Embase searches for papers pertaining to heterotopic pancreas.Publications describing symptomatic presentation of HP were selected for review.Information including demographics,symptoms,presentation and treatment were compiled and analyzed.RESULTS Twenty-nine patient were identified with HP at a single center,with six of these identified has having clinical symptoms.Clinical manifestations included,gastrointestinal bleeding,gastric ulceration with/without perforation,pancreatitis,and gastric outlet obstruction.Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients.Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients.The majority of patients presented with abdominal pain(67%)combined with one of the following clinical categories:(1)Dyspepsia,(n=445,48%);(2)Pancreatitis(n=260,28%);(3)Gastrointestinal bleeding(n=80,9%);and(4)Gastric outlet obstruction(n=80,9%).The majority of cases(n=832,90%)underwent surgical or endoscopic resection with 85%reporting resolution or improvement in their symptoms.CONCLUSION Heterotopic pancreas can cause significant clinical symptoms in the upper gastrointestinal tract.Better understanding and classification of this disease may result in more accurate identification and treatment of this malformation.

Neuromuscular electrical stimulation and testosterone did not influence heterotopic ossification size after spinal cord injury: A case series

Neuromuscular electrical stimulation(NMES) and testosterone replacement therapy(TRT) are effective rehabilitation strategies to attenuate muscle atrophy and evoke hypertrophy in persons with spinal cord injury(SCI). However both interventions might increase heterotopic ossification(HO) size in SCI patients. We present the results of two men with chronic traumatic motor complete SCI who also had pre-existing HO and participated in a study investigating the effects of TRT or TRT plus NMES resistance training(RT) on body composition. The 49-year-old male, Subject A, has unilateral HO in his right thigh. The 31-year-old male, Subject B, has bilateral HO in both thighs. Both participants wore transdermal testosterone patches(4-6 mg/d) daily for 16 wk. Subject A also underwent progressive NMES-RT twice weekly for 16 wk. Magnetic resonance imaging scans were acquired prior to and post intervention. Cross-sectional areas(CSA) of thewhole thigh and knee extensor skeletal muscles, femoral bone, and HO were measured. In Subject A(NMES-RT + TRT), the whole thigh skeletal muscle CSA increased by 10%, the knee extensor CSA increased by 17%, and the HO + femoral bone CSA did not change. In Subject B(TRT), the whole thigh skeletal muscle CSA increased by 13% in the right thigh and 6% in the left thigh. The knee extensor CSA increased by 7% in the right thigh and did not change in the left thigh. The femoral bone and HO CSAs in both thighs did not change. Both the TRT and NMES-RT + TRT protocols evoked muscle hypertrophy without stimulating the growth of preexisting HO.

An unusual cause of cholecystitis:Heterotopic pancreatic tissue in the gallbladder

Gallbladder localization of heterotopic pancreas （HP） is uncommon and very rarely gives rise to symptoms. Herein we report a case of HP found in the gallbladder neck presented with signs and symptoms of cholecystitis. The patient was a 40-year old male, suffering from epigastric pain, abdominal fullness and fever. On physical examination, the right upper abdomen was tender with a positive Murphy＇s sign. Ultrasonographic examination showed a hydropic gallbladder without stones and he underwent a cholecystectomy. Pathological examination revealed an intramural nodule （9 ram） in the neck region which is consisted of acini, ducts and islet cells of an aberrant pancreatic tissue. Although HP is encountered rarely in the gallbladder and is found incidentally during pathological studies, this case emphasizes that HP might cause symptoms and present clinically as cholecystitis. For this reason, in patients presenting with symptomatic gallbladder diseases, including cholecystitis without any other pathology, HP should be taken into consideration before it is diagnosed as ＂idiopathic＇：

Adenocarcinoma arising from intrahepatic heterotopic pancreas: A case report and literature review

Heterotopic pancreas is mostly found incidentally, and adenocarcinoma arising from heterotopic pancreas appears to be extremely rare. A case of a 46-year-old woman with adenocarcinoma arising from intrahepatic heterotopic pancreas is reported herein. Computed tomography demonstrated a mass located in the bile duct of the left hepatic lobe. Pathological examination revealed a moderately differentiated adenocarcinoma arising from intrahepatic heterotopic pancreas with nerve infiltration. This may be the first reported case of adenocarcinoma arising from intrahepatic heterotopic pancreas.

Successfully Man aging Cornual Heterotopic Pregnancy: A Case Report and Literature Review

Cornual heterotopic pregnancy is an extremely rare,life-threatening complication during pregnancy.Here,we report a 33-year-old woman who suffered cornual heterotopic pregnancy after in vitro fertilization embryo transfer.To prevent rupture during heterotopic pregnancy,she received laparoscopic surgery to remove the ectopic gestational sac at 7^(+2) weeks of gestation.Ultimately,she delivered a healthy boy at 38^(+3) weeks of gestation.Here,we also review the clinical presentations,risk factors,treatment options and outcomes of cornual heterotopic pregnancy.

Transvaginal Reduction of a Heterotopic Cornual Pregnancy with Conservation of Intrauterine Pregnancy

Here we report a case of heterotopic cornual pregnancy after in vitro fertilization who was diagnosed at 6 weeks after frozen embryos transfer.The heterotopic pregnancy was successfully terminated by transvaginal ultrasound-guided selective fetal reduction.At 38+1 weeks,she underwent a cesarean section and delivered a healthy 3300 g male infant with Apgar score of 10-10’evaluated at 1 min and 5 min.

Heterotopic pancreas adenocarcinoma in the stomach: A case report and literature review

BACKGROUND Heterotopic pancreas is a common lesion found in the gastrointestinal tract and is usually considered a benign disease.Reports of malignant change of heterotopic pancreas are scarce.CASE SUMMARY A 44-year-old Chinese female underwent a gastroscopy to assess abdominal distension that had persisted for 2 months.A protruding lesion in the gastric antrum was revealed but no malignant tissue was found in the biopsy specimen.The patient's symptom persisted and progressed to repeated vomiting.Endoscopy after 4 months revealed obstruction of the gastric outlet caused by the protruding lesion.A distal gastrectomy was performed.Histopathological examination of the surgical specimen showed the malignant transformation of aberrant pancreas in the stomach.Chemotherapy consisting of folinic acid,fluorouracil,and oxaliplatin was administered for three cycles,and was changed to gemcitabine monotherapy because of adverse effects and increased serum tumor marker levels.The patient remained asymptomatic during a 12-month follow-up.CONCLUSION Pancreatic heterotopy should be considered as source of a potentially malignant lesion,and early treatment or close monitoring for aberrant pancreas is recommended.

Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum:Clinical experience and endoscopic management

Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.