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Kiriyama Y, Tsukamoto T, Mizoguchi Y, Ishihara S, Horiguchi A, Tokoro T, Kato Y, Sugioka A, Kuroda M. Intrahepatic peribiliary perivascular epithelioid cell tumor (PEComa) associated with heterotopic pancreas: A case report. Diagn Pathol 2016; 11:81. [PMID: 27542598 PMCID: PMC4992331 DOI: 10.1186/s13000-016-0528-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/06/2016] [Indexed: 03/05/2023] Open
Abstract
Background Perivascular epithelioid-cell tumor (PEComa) is a group of rare mesenchymal neoplasms that express myomelanocytic-cell markers and exhibit a wide variety of histopathological features. Although heterotopic pancreas has been reported to occur in the gastrointestinal tract, intrahepatic heterotopic pancreas has been reported only rarely. Case presentation We present a case of intrahepatic PEComa that showed a strong regional correlation with the presence of heterotopic pancreas. An intrahepatic tumor and biliary dilatation was incidentally discovered during a diagnostic evaluation to investigate low-back pain in a 47-year-old Japanese male. Cholangiocarcinoma was suspected and a left hemihepatectomy performed. Histological examination revealed a 3 × 3.8-mm tumor in the neighboring B2 bile duct. Histological and immunohistochemical investigations revealed the presence of a PEComa and pancreatic acini within the tumor mass. PEComa in the hepatobiliary and pancreatic regions are extremely rare. The presence of heterotopic pancreas is also relatively uncommon. Conclusion The strong regional association of these 2 lesions raises the possibility of a PEComa originating from heterotopic pancreas or from an irritable response caused by heterotopic pancreas.
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Affiliation(s)
- Yuka Kiriyama
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Tsukamoto
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Yoshikazu Mizoguchi
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Shin Ishihara
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akihiko Horiguchi
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takamasa Tokoro
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yutaro Kato
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Kuroda
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Senthil Kumar MP, Marudanayagam R. Klatskin-like lesions. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:107519. [PMID: 22811587 PMCID: PMC3395250 DOI: 10.1155/2012/107519] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/08/2012] [Indexed: 12/20/2022]
Abstract
Hilar cholangiocarcinoma, also known as Klatskin tumour, is the commonest type of cholangiocarcinoma. It poses unique problems in the diagnosis and management because of its anatomical location. Curative surgery in the form of major hepatic resection entails significant morbidity. About 5-15% of specimens resected for presumed Klatskin tumour prove not to be cholangiocarcinomas. There are a number of inflammatory, infective, vascular, and other pathologies, which have overlapping clinical and radiological features with a Klatskin tumour, leading to misinterpretation. This paper aims to summarise the features of such Klatskin-like lesions that have been reported in surgical literature.
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Affiliation(s)
- M. P. Senthil Kumar
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
- Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital Birmingham, 3rd Floor Nuffield House, Edgbaston, Birmingham B15 2TH, UK
| | - R. Marudanayagam
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
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Yan ML, Wang YD, Tian YF, Lin Y. Adenocarcinoma arising from intrahepatic heterotopic pancreas: A case report and literature review. World J Gastroenterol 2012; 18:2881-4. [PMID: 22719201 PMCID: PMC3374996 DOI: 10.3748/wjg.v18.i22.2881] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 01/04/2012] [Accepted: 01/18/2012] [Indexed: 02/06/2023] Open
Abstract
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.
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Deshpande VP, Raghunath BV, Sarin YK, Sinha S. Heterotopic pancreas causing duodenal obstruction in a patient previously treated for choledochal cyst. J Indian Assoc Pediatr Surg 2012; 17:40-2. [PMID: 22279366 PMCID: PMC3263040 DOI: 10.4103/0971-9261.91088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A 9-year-old boy presented with duodenal pancreatic rest causing obstruction and required surgical intervention. He had been treated at the age of 4 months for a choledochal cyst. Both choledochal cyst and heterotopic pancreas are entities that are commonly encountered in children, but the incidental presence of both the entities in the same child, albeit presenting metachronously, is extremely rare.
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Affiliation(s)
- Vidyanand P Deshpande
- Department of Paediatric Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
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Heterotopic pancreatic tissue in the cystic duct: complicating factor or coexisting pathology. South Med J 2010; 103:471-3. [PMID: 20375939 DOI: 10.1097/smj.0b013e3181d839c4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented. Ultrasound showed gallstones without inflammation of the gallbladder. The patient underwent laparoscopic cholecystectomy and her symptoms resolved. Histological examination of the operation specimen disclosed heterotopic pancreatic tissue within the cystic duct. An accurate clinical diagnosis of pancreatic heterotopia is difficult. The deep submucosal or intramural location of the lesion may hamper retrieval of representative biopsy material. Indications for surgery or endoscopic resection include symptomatic lesions as well as cases of unclear histological examination in order to distinguish pancreatic heterotopia from other tumors.
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