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Berkarda Z, Kuvendjiska J, Bamberg F, Kotter E. Ectopic pancreas tissue in the posterior mediastinum. J Cardiothorac Surg 2024; 19:184. [PMID: 38582893 PMCID: PMC10998290 DOI: 10.1186/s13019-024-02698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/27/2024] [Indexed: 04/08/2024] Open
Abstract
The occurrence of ectopic pancreas in the mediastinum is rare. Herein, we report a 22-year-old female who presented with right shoulder pain, dysphagia, fever and headaches. Chest computer tomography revealed a mass in the posterior mediastinum with accompanying signs of acute mediastinitis. Needle biopsy and fine-needle aspiration revealed ectopic gastral tissue and ectopic pancreas tissue, respectively. Surgical resection was attempted due to recurring acute pancreatitis episodes. However, due to chronic-inflammatory adhesions of the mass to the tracheal wall, en-bloc resection was not possible without major tracheal resection. Since then, recurring pancreatitis episodes have been treated conservatively with antibiotics. We report this case due to its differing clinical and radiological findings in comparison to previous case reports, none of which pertained a case of ectopic pancreas tissue in the posterior mediastinum with recurring acute pancreatitis and mediastinitis.
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Affiliation(s)
- Zeynep Berkarda
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg, Germany.
| | - Jasmina Kuvendjiska
- Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Elmar Kotter
- Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Freiburg, Germany
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2
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Teresa Gómez Hernández M, Chinchilla-Tábora LM, Luis Aranda Alcaide J. SÍNDROME DE VENA CAVA SUPERIOR SECUNDARIO A CARCINOMA DE CÉLULAS EN ANILLO DE SELLO MEDIASTÍNICO DE ORIGEN PRIMARIO DESCONOCIDO. OPEN RESPIRATORY ARCHIVES 2022. [PMID: 37497324 PMCID: PMC10369572 DOI: 10.1016/j.opresp.2022.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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3
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Anterior mediastinal ectopic pancreatic cyst incidentally identified by pericarditis: a case report. Gen Thorac Cardiovasc Surg 2020; 69:597-600. [PMID: 33136258 DOI: 10.1007/s11748-020-01537-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/16/2020] [Indexed: 01/07/2023]
Abstract
Ectopic pancreas often occurs in the gastrointestinal tract. However, the identification of a mediastinal ectopic pancreas is extremely rare. Herein, we report a case of ectopic pancreas of the anterior mediastinum, which was incidentally detected during treatment for pericarditis with widespread ST elevation on electrocardiogram. A 40-year-old woman complaining of chest pain was admitted with suspected pericarditis. A closer examination revealed a cystic mass in the anterior mediastinum, which was diagnosed as a pancreatic cyst of the anterior mediastinum on thoracoscopic tumor resection.
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4
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Stewart BD, VandenBussche CJ, Leon ME. Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens. Semin Diagn Pathol 2020; 37:199-210. [PMID: 32534865 DOI: 10.1053/j.semdp.2020.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/01/2020] [Indexed: 01/03/2023]
Abstract
This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.
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Affiliation(s)
- Brian D Stewart
- University of Florida College of Medicine Department of Pathology, Immunology and Laboratory Medicine P.O. Box 100275 1600 SW Archer Road Gainesville, FL 32610-0275.
| | - Christopher J VandenBussche
- Johns Hopkins University School of Medicine, Department of Pathology, 600 N. Wolfe Street Baltimore, MD 21287
| | - Marino E Leon
- University of Florida College of Medicine Department of Pathology, Immunology and Laboratory Medicine P.O. Box 100275 1600 SW Archer Road Gainesville, FL 32610-0275
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5
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Zhao H, Zhang Z, Li X, Liu J, Zhang H, Chen G, Chen J. Resection of anterior mediastinal ectopic pancreas by right thoracoscopy: A case report. Mol Clin Oncol 2019; 11:147-150. [PMID: 31316773 DOI: 10.3892/mco.2019.1878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/10/2019] [Indexed: 11/06/2022] Open
Abstract
Ectopic pancreas is uncommon in the anterior mediastinum. Herein, a 32-year-old woman presented to our institution for investigation of an abnormal mediastinal shadow on chest computed tomography. The patient underwent complete surgical resection of the anterior mediastinal mass by right thoracoscopy, and the postoperative pathology examination confirmed the diagnosis of ectopic pancreas. There were no clinical signs of pancreatitis. No recurrence or metastasis was observed during a follow-up period of 3 years. English language medical literature was also searched in order to identify other case reports describing this rare condition and identified 17 papers describing 20 cases of anterior mediastinal ectopic pancreas, which were all confirmed at surgery. All clinical characteristics in these cases were reviewed.
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Affiliation(s)
- Honglin Zhao
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Zihe Zhang
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Xin Li
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Jinghao Liu
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Hongbing Zhang
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Gang Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Jun Chen
- Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
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6
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Cazacu IM, Luzuriaga Chavez AA, Nogueras Gonzalez GM, Saftoiu A, Bhutani MS. Malignant Transformation of Ectopic Pancreas. Dig Dis Sci 2019; 64:655-668. [PMID: 30415408 DOI: 10.1007/s10620-018-5366-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 11/01/2018] [Indexed: 02/07/2023]
Abstract
Malignant transformation of ectopic pancreas tissue is a diagnostic challenge as clinical symptoms and radiographic features of these tumors are non-specific. Given the rarity of these lesions, it is usually neither suspected nor included in the diagnostic workup of different tumors. We conducted a comprehensive literature review regarding malignancy arising from ectopic pancreas for a better understanding of its frequency, clinicopathological features, and prognosis. A literature search was performed in three major databases: PubMed, Cochrane, and Web of Science. Fifty-four well-documented cases of malignant ectopic pancreas were identified in the published literature. Our analysis provided the following observations: (1) there was a slight predominance of males over females; (2) most patients with malignant transformation of ectopic pancreas were middle-aged; (3) most commonly, the tumor was located in the stomach; (4) most tumors were adenocarcinomas; (5) most frequently, the malignancy arose within a type I heterotopia according to Heinrich classification; (6) macroscopically, a subepithelial-like appearance was most frequently observed; and (7) improved prognosis for ectopic pancreatic malignancies in comparison with reported survival data for orthotopic pancreatic cancer. Even if the majority of cases of ectopic pancreas are incidental findings and malignant transformation is a rare event, pancreatic heterotopy should be considered as a source of potentially malignant lesions.
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Affiliation(s)
- Irina M Cazacu
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adriana Alexandra Luzuriaga Chavez
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Graciela M Nogueras Gonzalez
- Department of Biomathematics and Biostatistics, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, 66 1 Mai Blvd., 200638, Craiova, Romania
| | - Manoop S Bhutani
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030-4009, USA.
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Mediastinal Ectopic Pancreas with Abundant Endocrine Cells Coexisting with Mediastinal Cyst and Thymic Hyperplasia. Case Rep Pathol 2018; 2018:8270516. [PMID: 29977637 PMCID: PMC5994262 DOI: 10.1155/2018/8270516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/19/2018] [Indexed: 12/16/2022] Open
Abstract
Mediastinal ectopic pancreas is a rare condition with only 28 cases reported in the literature. Here we report a 21-year-old female patient who presented with dyspnea and intermittent severe chest pain of 7 years' duration. Computerized tomography scan (CT-scan) of the chest revealed a mediastinal cyst. The cyst was resected and it demonstrated on histopathological examination the presence of pancreatic tissue with increased number of islets of Langerhans, coexistent with mediastinal cyst and thymic hyperplasia. We made a review of all previously reported cases of this entity.
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Heterotopic Pancreas of the Gastrointestinal Tract and Associated Precursor and Cancerous Lesions: Systematic Pathologic Studies of 165 Cases. Am J Surg Pathol 2017; 41:833-848. [PMID: 28368927 DOI: 10.1097/pas.0000000000000850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heterotopic pancreas (HP) can be detected by accompanying symptoms or incidentally during gastrointestinal (GI) tract tumor resection. We compared clinicopathologic features among 165 resected HPs (57 gastric [35%], 56 duodenal [34%], 30 omental [18%], and 22 jejunal [13%]). Symptomatic HPs (79/135 GI tract wall HPs, 59%) were larger (P=0.05), more common in younger patients and in a gastric location (both P<0.001), and more frequently associated with lymphoid cuffs (P=0.03) than incidentally found HPs. Gastric/jejunal HPs were more frequently symptomatic (P<0.001), deeply located (P=0.03), and associated with lymphoid cuffs (P=0.008) and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; P=0.001) than duodenal HPs. HP was frequently associated with acinar-ductal metaplasias (117/135 GI tract wall HPs, 87%) and PanINs/IPMNs (68/135, 50%); those with PanINs/IPMNs were larger (P<0.001), more frequently located in stomach (P=0.001), had deeper wall involvement (P=0.03), and more often showed infiltrative growth (P<0.001) and lymphoid cuffs (P=0.02). Four HPs containing PanINs abutted adenocarcinomas, all expressing wild-type KRAS and intact SMAD4/DPC4 expression. Thus, symptomatic HP is associated with younger age, larger size, gastric location, and lymphoid cuffs. HPs containing PanINs/IPMNs (usually low grade) are larger and more common in stomach, have deeper wall location, and show infiltrative growth and lymphoid cuffs. Adenocarcinomas are rarely observed adjacent to HPs with PanINs/IPMNs. KRAS mutational and SMAD4/DPC4 immunohistochemical studies can discriminate between adenocarcinoma derived from HP and concurrent adenocarcinoma with HP.
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Koh HM, Chang JW, Jeong SY, Hyun CL, Kim YS, Jang BG, Maeng YH. Ectopic Pancreas Presenting as a Solid Mediastinal Mass. Int J Surg Pathol 2015. [DOI: 10.1177/1066896915596810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ectopic pancreas is a well-known developmental anomaly found in approximately 2% of all autopsies, frequently in the gastrointestinal tract. Mediastinal pancreatic ectopia is very rare; only a few cases have been described in the English-language literature. According to previous reports, the pancreatic tissue is detected in the cyst wall or appears as small solid components of cystic masses within the anterior mediastinum. In this report, we present a case of ectopic pancreas appearing as a large solid mass in the anterior mediastinum of a 17-year-old male patient.
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Affiliation(s)
- Hyun Min Koh
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Jee Won Chang
- Department of Thoracic and Cardiovascular Surgery, Jeju National University School of Medicine, Jeju, Korea
| | - Sun Young Jeong
- Department of Radiology, Jeju National University School of Medicine, jeju, Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Sill Kim
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Bo Geun Jang
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
| | - Young Hee Maeng
- Department of Pathology, Jeju National University School of Medicine, Jeju, Korea
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10
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Li WW, van Boven WJ, Jurhill RR, Bonta PI, Annema JT, de Mol BA. Ectopic pancreas in a giant mediastinal cyst. CLINICAL RESPIRATORY JOURNAL 2014; 10:125-8. [DOI: 10.1111/crj.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 05/25/2014] [Accepted: 06/22/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Wilson W. Li
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Wim Jan van Boven
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
| | - Roy R. Jurhill
- Department of Pathology; University of Amsterdam; Amsterdam the Netherlands
| | - Peter I. Bonta
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Jouke T. Annema
- Department of Respiratory Medicine, Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - Bas A. de Mol
- Department of Cardiothoracic Surgery; University of Amsterdam; Amsterdam the Netherlands
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11
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Zhang L, Peng LQ, Yu JQ, Yuan HM, Chu ZG, Zeng HJ, Wei B. Ectopic pancreas in the anterior mediastinum: A report of two cases and review of the literature. Oncol Lett 2014; 7:1053-1056. [PMID: 24660035 PMCID: PMC3961199 DOI: 10.3892/ol.2014.1840] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 01/07/2014] [Indexed: 02/05/2023] Open
Abstract
Ectopia of the pancreatic tissue is a developmental anomaly found in ~2% of all autopsies, and 70~90% of these anomalies are located in the gastrointestinal tract. Mediastinal localization of an ectopic pancreas is extremely rare. Herein, we report two cases with mediastinal ectopic pancreas clarified by pathology and shown by thoracic contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). In addition, a brief review of the relevant literatures is presented. Although CT and MRI manifestations of this lesion are nonspecific, certain notable findings need to be focused on. When there is a mass in the anterior mediastinum with marked and heterogeneous enhancement, along with necrotic and liquefied non-enhanced areas in the center, ectopic pancreas should be considered and differentiated from other neoplasms in this region.
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Affiliation(s)
- Lizhi Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Li-Qing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jian-Qun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hong-Mei Yuan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhi-Gang Chu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Han-Jiang Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bing Wei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Rokach A, Izbicki G, Deeb M, Bogot N, Arish N, Hadas-Halperen I, Azulai H, Bohadana A, Golomb E. Ectopic pancreatic pseudocyst and cyst presenting as a cervical and mediastinal mass: case report and review of the literature. Diagn Pathol 2013; 8:176. [PMID: 24152726 PMCID: PMC3817996 DOI: 10.1186/1746-1596-8-176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Ectopic pancreas in the mediastinum is extremely rare. We are reporting on a case of a twenty two year old woman who presented to our clinic with a large cervical mass. The CT scan revealed a cystic lesion in the anterior mediastinum. The patient underwent surgical resection by cervical approach. A Cystic mass with pseudocysts, cysts and complete pancreatic tissue were found in pathology. There were no signs of pancreatitis or malignancy. No recurrence was observed after a follow up of four years. We reviewed the case reports describing this rare condition in the medical literature.We conclude that the possibility of ectopic pancreatic tissue should be included in the differential diagnosis of anterior mediastinal cystic mass, though as a remote possibility. Surgery is probably needed for the diagnosis and treatment. Posterior mediastinal pseudocyst is a different entity associated with acute pancreatitis. In those cases surgery is not recommended. Our third conclusion is that pancreatic tissue should be actively sought, if a structure resembling a pseudocyst is found in an unexpected location. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1849369005957671.
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Affiliation(s)
| | - Gabriel Izbicki
- The Institute of Pulmonology, Shaare Zedek Medical Center, Jerusalem, Israel.
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