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Kumar NA, DSouza AS, Usman N, Bishnoi AK. Agenesis of Dorsal Pancreas and Solid Pseudopapillary Tumor: Ventral Pancreas Preserving Portal Vein Resection and Reconstruction Using a Peritoneal Graft. Cureus 2023; 15:e40916. [PMID: 37496552 PMCID: PMC10366649 DOI: 10.7759/cureus.40916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/28/2023] Open
Abstract
A diabetic lady in her 40s was referred to surgical oncologists with epigastric pain associated with vomiting. Computed Tomography (CT) Abdomen with contrast demonstrated a mass arising from the head of the pancreas with the absence of dorsal pancreas, confirmed on magnetic resonance cholangio-pancreatography (MRCP). A core needle biopsy was done, and the tumor was revealed to be a solid pseudopapillary epithelial neoplasm. She underwent sub-total pancreatectomy preserving the duodenum and ventral pancreas as there was adequate free margin; however due to the tumor abutting the anterior wall of the portal vein, it was resected, and reconstruction was done using a peritoneal graft. The patient made a good recovery without any significant post-operative events.
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Affiliation(s)
- Naveena An Kumar
- Surgical Oncology, Kasturba Medical College, Manipal, Udupi, IND
| | - Arika S DSouza
- Surgical Oncology, Kasturba Medical College, Manipal, Udupi, IND
| | - Nawaz Usman
- Surgical Oncology, Kasturba Medical College, Manipal, Udupi, IND
| | - Arvind K Bishnoi
- Cardiothoracic Surgery, Kasturba Medical College, Manipal, Udupi, IND
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Namikawa T, Utsunomiya M, Yokota K, Kawanishi Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Laparoscopic total gastrectomy for concurrent gastric cancer and complete agenesis of the dorsal pancreas. Asian J Endosc Surg 2022; 16:266-270. [PMID: 36148900 DOI: 10.1111/ases.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Abstract
We present an unusual case of laparoscopic total gastrectomy with lymph node dissection in a 56-year-old woman with gastric cancer and agenesis of the dorsal pancreas (ADP). Esophagogastroduodenoscopy revealed erosive lesions with thickened gastric folds; biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography showed a thickened wall of the gastric body; the distal pancreas was not visualized. Under the clinical diagnosis of gastric cancer with ADP, the patient underwent laparoscopic total gastrectomy with standard lymphadenectomy. The absence of a pancreatic neck, body, and tail was confirmed; lymph nodes along the splenic artery were dissected. Pathological analysis demonstrated a poorly differentiated adenocarcinoma invading the serosa, with five lymph node metastases. The postoperative course was unremarkable; postoperative adjuvant chemotherapy was performed using S-1 plus oxaliplatin. No symptom recurrence was observed at the 6-month follow-up. Laparoscopic surgery, with careful preoperative anatomic evaluation, can be considered for concurrent gastric cancer and ADP.
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Affiliation(s)
| | | | | | | | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi, Japan
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Valiyeva S, Romano L, Schietroma M, Carlei F, Giuliani A. Partial agenesis of dorsal pancreas. Report of two cases. Int J Surg Case Rep 2020; 77S:S17-S20. [PMID: 33168455 PMCID: PMC7876736 DOI: 10.1016/j.ijscr.2020.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 12/15/2022] Open
Abstract
Agenesis of the dorsal pancreas is a rare congenital anomaly. The possibility of finding this disorder is increasing with the use of advanced radiological techniques. Some patients experience no symptoms. Rarely, they may also develop pancreatic exocrine insufficiency or pancreatic adenocarcinoma. This diagnosis could be missed by US, due to difficulty on visualization of body and tail of pancreas.
Introduction Agenesis of the dorsal pancreas (ADP) is a rare congenital anomaly resulting in missing corpus and cauda of the pancreas. The possibility of finding this disorder is increasing with the use of advanced radiological techniques like CT scan or MRI. Presentation of case We reported 2 cases of a partial ADP as radiological finding: the first one was a 79-year-old asymptomatic patient who presented to perform a CT staging scan for bladder tumor, while the second case was a 73-year-old patient with obstructive jaundice and with suspected common bile duct calculi. In the second patient US, CT scan and MRI were performed, and after that also an ERCP was scheduled. Discussion The prevalence of agenesis of the dorsal pancreas is not exactly known; in the literature, only 50 cases have been reported. Its cause and pathogenesis are not fully understood. Some patients experience no symptoms, while others may develop hyperglycemia, diabetes mellitus, bile duct obstruction, abdominal pain, pancreatitis, or other conditions. Conclusion Considering that dorsal agenesis is sporadically found, often do not have related symptoms and it does not require a specific treatment, whether further examinations are needed to determine the type of agenesis remains questioned.
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Affiliation(s)
- Sayali Valiyeva
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy.
| | - Mario Schietroma
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Francesco Carlei
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Department of Surgery, San Salvatore Hospital, Italy
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Yang T, Yang X, Wang L, Mo J. Agenesis of the dorsal pancreas presenting with diabetic ketoacidosis - a case report and literature review. BMC Endocr Disord 2019; 19:120. [PMID: 31711495 PMCID: PMC6849212 DOI: 10.1186/s12902-019-0449-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Agenesis of the dorsal pancreas (ADP) is clinically rare, and it is usually accompanied by abdominal pain. Various disorders of glucose metabolism associating with ADP have been reported, but there are only two studies reporting a correlation between ADP and DKA in English literature. CASE PRESENTATION We present a case of a patient with ADP accompanied by abdominal pain and diabetic ketoacidosis as the initial clinical presentation. A 30-year-old man presented with a 3-month history of recurrent onset of persistent mild epigastric pain, which worsen when eating. Laboratory tests revealed metabolic acidosis, hyperglycemia, and ketonuria. Phase contrast CT and MRCP showed the absence of the body and tail of the pancreas, as well as the dorsal pancreatic duct. The C-peptide release test indicated β-cell dysfunction. A combination therapy of insulin, pancreatic enzyme supplements, and mosapride citrate were administrated and the pain gradually resolved. CONCLUSIONS As glucose metabolism disorders can vary across different individuals, we advise clinicians to consider the diagnosis of ADP for a patient who presents with a glucose metabolism disorder accompanied by abdominal pain, pancreatitis or steatorrhea.
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Affiliation(s)
- Tian Yang
- Department of Endocrinology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000, Shangcheng Road N1, Yiwu, Zhejiang, China
| | - Xudan Yang
- Department of Internal Medicine, Jinhua Municipal Central Hospital of, Zhejiang University, Jinhua, Zhejiang, 321000 China
| | - Luping Wang
- Department of Endocrinology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, 322000, Shangcheng Road N1, Yiwu, Zhejiang, China
| | - Jun Mo
- Department of Neurosurgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, Zhejiang, 322000 China
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Zhong JW, Yu LM, Ying QJ, Peng WW, Xu CZ, Cai ZZ, Xue ZX, Zhou YH. Performance of endoscopic ultrasound for diagnosis of agenesis of the dorsal pancreas: a case report. J Int Med Res 2019; 48:300060519884148. [PMID: 31680602 PMCID: PMC7265568 DOI: 10.1177/0300060519884148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Agenesis of the dorsal pancreas is a rare congenital pancreatic malformation. We herein
describe a 67-year-old woman with a 5-day history of lower back pain who was eventually
diagnosed with agenesis of the dorsal pancreas. Abdominal computed tomography showed an
enlarged pancreatic head, but the pancreatic body and tail were invisible. The magnetic
resonance imaging findings were similar to the computed tomography findings. Magnetic
resonance cholangiopancreatography showed that the major pancreatic duct was mildly
dilated but otherwise normal. Endoscopic ultrasound revealed absence of the pancreatic
body and tail, an enlarged head of the pancreas, and mild pancreatic duct dilation. The
final diagnosis was dorsal pancreatic agenesis.
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Affiliation(s)
- Jin Wei Zhong
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ling Min Yu
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Qing Ji Ying
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Wen Wen Peng
- Department of Radiology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Chang Zhao Xu
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhen Zhai Cai
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zhan Xiong Xue
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yu Hui Zhou
- Department of Gastroenterology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Three cases of pancreatic pseudocysts associated with dorsal pancreatic agenesis. Radiol Case Rep 2018; 14:79-82. [PMID: 30377453 PMCID: PMC6202790 DOI: 10.1016/j.radcr.2018.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/16/2018] [Accepted: 09/28/2018] [Indexed: 02/06/2023] Open
Abstract
Agenesis of the dorsal pancreas (ADP) is an extremely rare congenital anomaly. Human pancreas is formed by ventral and dorsal endodermal buds of the foregut endoderm. The dorsal bud forms the upper part of the head, neck, body, and tail of the pancreas and the ventral bud generates most of the head and uncinate process. ADP is derived from the embryologic failure of the dorsal pancreatic bud to form the pancreatic body and tail. ADP can be related to some diseases and conditions such as pancreatitis, hypoglycemia, and rarely pancreatic tumors. The association between cystic lesions with ADP has previously been reported. Three cases of cystic lesions of the pancreas with ADP were diagnosed clinically based on the imaging features and without any past history of pancreatitis. However, the pathologic diagnosis of resected lesions confirmed pseudocysts without pathologic evidence of tumor. We report 3 cases of pancreatic pseudocysts associated with ADP
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Salman R, Barakat A, Berjawi G. Dorsal pancreatic agenesis in newly diagnosed type one diabetes mellitus: case report and review of literature. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Erotokritou A, Gerharz CD, Sagir A. Agenesis of dorsal pancreas associated with pancreatic neuroendocrine tumor: a case report and review of the literature. J Med Case Rep 2018; 12:185. [PMID: 29958547 PMCID: PMC6026343 DOI: 10.1186/s13256-018-1733-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background Agenesis of the dorsal pancreas is very rare. Less than 70 cases have been reported to date. Some of these cases had an association with a tumor. The literature of agenesis of the dorsal pancreas and agenesis of the dorsal pancreas-associated pancreatic neoplasia is limited. Here we report the second case of a pancreatic neuroendocrine tumor in a setting of agenesis of the dorsal pancreas. Case presentation A 71-year-old man, originally from North Africa, with a history of insulin-dependent diabetes mellitus, presented with a 2-month history of nonspecific abdominal symptoms. Contrast-enhanced computed tomography demonstrated an almost 3 cm round, quite well-defined and homogeneous tumor formation in the area between the neck and absent body and tail of his pancreas. The mass was confirmed by endoscopic ultrasound. Our patient underwent computed tomography-guided biopsy of the mass which provided proof of a neuroendocrine tumor. He underwent pancreas resection because of the presence of a neuroendocrine tumor. Seven months later his glycated hemoglobin increased from 6.9 to 8.7%. Conclusions Diagnosis of agenesis of the dorsal pancreas is based on imaging techniques like computed tomography, magnetic resonance cholangiopancreatography, or endoscopic ultrasound. Endoscopic ultrasound-guided fine-needle aspiration can be helpful for the histological diagnosis of the tumor. The hypothesis of the association between pancreatic neoplasia and agenesis of the dorsal pancreas leads us to the suggestion that every patient with diagnosed agenesis of the dorsal pancreas should be observed with a focus on the early detection of potential malignancy.
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Affiliation(s)
- A Erotokritou
- Department of Gastroenterology, Academic Teaching Hospital Bethesda Duisburg, Heerstr, 219 47053, Duisburg, Germany
| | - C D Gerharz
- Department of Pathology, Academic Teaching Hospital Bethesda Duisburg, Heerstr. 219, 47053, Duisburg, Germany
| | - A Sagir
- Department of Gastroenterology, Academic Teaching Hospital Bethesda Duisburg, Heerstr, 219 47053, Duisburg, Germany.
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