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Yang X, Liu C, Sun S, Dong C, Zhao S, Bokhary ZM, Liu N, Wu J, Ding G, Zhang S, Geng L, Liu H, Fu T, Gao X, Niu Q. Clinical features and treatment of heterotopic pancreas in children: a multi-center retrospective study. Pediatr Surg Int 2024; 40:141. [PMID: 38811418 PMCID: PMC11136705 DOI: 10.1007/s00383-024-05722-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.
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Affiliation(s)
- Xiaofeng Yang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chen Liu
- Department of Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuai Sun
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Dong
- Department of General Surgery, Zibo Hospital of Shandong Yiyang Health Industry Development Group Co, Ltd, Zibo, China
| | - Shanshan Zhao
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zaitun M Bokhary
- Department of Pediatric Surgery, Muhimbili National Hospital, Dar Es Salaam, Tanzania
| | - Na Liu
- Department of Pathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Jinghua Wu
- Department of Pediatric Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China
| | - Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China.
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China.
| | - Xiangqian Gao
- Department of Pathology, Binzhou Medical University Hospital, Binzhou, China.
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China.
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Sun K, Yu S, Wang Y, Jia R, Shi R, Liang C, Wang X, Wang H. Development of a multi-phase CT-based radiomics model to differentiate heterotopic pancreas from gastrointestinal stromal tumor. BMC Med Imaging 2024; 24:44. [PMID: 38355484 PMCID: PMC10868069 DOI: 10.1186/s12880-024-01219-2] [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: 06/09/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND To investigate whether CT-based radiomics can effectively differentiate between heterotopic pancreas (HP) and gastrointestinal stromal tumor (GIST), and whether different resampling methods can affect the model's performance. METHODS Multi-phase CT radiological data were retrospectively collected from 94 patients. Of these, 40 with HP and 54 with GISTs were enrolled between April 2017 and November 2021. One experienced radiologist manually delineated the volume of interest and then resampled the voxel size of the images to 0.5 × 0.5 × 0.5 mm3, 1 × 1 × 1 mm3, and 2 × 2 × 2 mm3, respectively. Radiomics features were extracted using PyRadiomics, resulting in 1218 features from each phase image. The datasets were randomly divided into training set (n = 66) and validation set (n = 28) at a 7:3 ratio. After applying multiple feature selection methods, the optimal features were screened. Radial basis kernel function-based support vector machine (RBF-SVM) was used as the classifier, and model performance was evaluated using the area under the receiver operating curve (AUC) analysis, as well as accuracy, sensitivity, and specificity. RESULTS The combined phase model performed better than the other phase models, and the resampling method of 0.5 × 0.5 × 0.5 mm3 achieved the highest performance with an AUC of 0.953 (0.881-1), accuracy of 0.929, sensitivity of 0.938, and specificity of 0.917 in the validation set. The Delong test showed no significant difference in AUCs among the three resampling methods, with p > 0.05. CONCLUSIONS Radiomics can effectively differentiate between HP and GISTs on CT images, and the diagnostic performance of radiomics is minimally affected by different resampling methods.
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Affiliation(s)
- Kui Sun
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Shuxia Yu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, No. 324, 250021, Jinan, China
| | - Ying Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China
| | - Rongze Jia
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong Provincial Hospital of Traditional Chinese Medicine, Jing Shi Road, No. 16369, 250014, Jinan, China
| | - Rongchao Shi
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jing Wu Road, No. 324, 250021, Jinan, China
| | - Changhu Liang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
| | - Haiyan Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jing Wu Road, NO. 324, 250021, Jinan, Shandong, China.
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Bullock C, Amiraian D, Almerey T, Stauffer J, Komforti MK, LeGout JD. The tale of 2 pancreases: Jejunal mesenteric ectopic pancreas causing recurrent ectopic pancreatitis. Radiol Case Rep 2024; 19:464-467. [PMID: 38046919 PMCID: PMC10692469 DOI: 10.1016/j.radcr.2023.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Ectopic pancreas, or the presence of pancreatic tissue separate from the anatomic pancreas, is rarely reported in locations other than the stomach or duodenum. A 43-year-old female was found to have a large jejunal mesenteric ectopic pancreas causing ectopic pancreatitis during workup for frequent episodes of abdominal pain. We present the imaging findings and postresection pathology findings of a rare jejunal ectopic pancreas and discuss the potential complications of this unique condition.
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Affiliation(s)
| | - Dana Amiraian
- Department of Radiology, Mayo Clinic Jacksonville FL, USA
| | - Tariq Almerey
- Department of Surgery, Mayo Clinic Jacksonville FL, USA
| | - John Stauffer
- Department of Surgery, Mayo Clinic Jacksonville FL, USA
| | - Miglena K. Komforti
- Department of Pathology and Laboratory Medicine, Mayo Clinic Jacksonville FL, USA
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Braga M, Matos AP, Marques PP, Ramalho M. Gastric ectopic pancreas in magnetic resonance imaging: A review of 2 cases. Radiol Case Rep 2023; 18:1181-1185. [PMID: 36660566 PMCID: PMC9842967 DOI: 10.1016/j.radcr.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 01/13/2023] Open
Abstract
Gastric ectopic pancreas (EP) is an uncommon congenital anomaly in which pancreatic tissue with no anatomic connection to the main pancreas is found in the stomach. Gastric EP is often discovered incidentally when a nonspecific submucosal tumor is found in endoscopic studies or other imaging examinations. Tissue characterization by biopsy or fine-needle aspiration is required as endoscopic findings alone cannot exclude malignancy. The authors present 2 cases of gastric EP incidentally detected on endoscopy, which underwent further characterization by magnetic resonance imaging (MRI). In both cases, MRI showed submucosal gastric lesions, isointense to the orthotopic pancreas in all sequences, including hyperintensity on T1-weighted images. Furthermore, the lesions showed bright arterial phase enhancement, paralleling the native pancreas. MRI may provide the best non-invasive imaging method for evaluating gastric submucosal lesions. This report intends to show that EP shows a characteristic MR appearance that allows differentiation from other submucosal lesions.
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Affiliation(s)
- Miguel Braga
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Corresponding author.
| | - António P. Matos
- Department of Radiology, Hospital CUF Tejo, Av. 24 de Julho 171A, 1350-352, Lisbon, Portugal
| | - Pedro Pinto Marques
- Department of Gastroenterology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta E.P.E., Av. Torrado da Silva, 2805-267, Almada, Portugal
- Department of Radiology, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisbon, Portugal
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Kim JH, Hwang J, Bae SH, Hong SS, Jin YM. Acute Ectopic Pancreatitis Mimicking Peptic Ulcer Disease: A Case Report. Curr Med Imaging 2022; 18:1000-1002. [PMID: 35068395 DOI: 10.2174/1573405618666220124102113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/24/2021] [Accepted: 12/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Ectopic pancreas is an anatomically separate pancreatic tissue from normal glands with its own vascular and ductal system and most commonly occurs in the upper gastrointestinal tract. Ectopic pancreas is usually asymptomatic, but it can present with symptoms associated with complications, including bleeding, inflammation, and neoplasm without abnormalities in the normal pancreas. CASE PRESENTATION We report a 31-year-old female with acute ectopic pancreatitis involving gastric antrum and proximal duodenum mimicking peptic ulcer disease, without pancreatitis in the normal pancreas. CONCLUSION Ectopic pancreatitis is a rare condition and can mimic more common diseases depending on the anatomical location.
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Affiliation(s)
- Jun Hyeok Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Sung Hwan Bae
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
| | - Yoon Mi Jin
- Department of Pathology, Soonchunhyang University College of Medicine, Seoul Hospital, Seoul, Republic of Korea
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Marín-Díez E, Crespo Del Pozo J. Diagnostic approach to small-bowel wall thickening: Beyond Crohn's disease and cancer. RADIOLOGIA 2021; 63:519-530. [PMID: 34801185 DOI: 10.1016/j.rxeng.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 11/26/2020] [Indexed: 10/19/2022]
Abstract
Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis.
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Affiliation(s)
- E Marín-Díez
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - J Crespo Del Pozo
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Yang CW, Che F, Liu XJ, Yin Y, Zhang B, Song B. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging 2021; 12:144. [PMID: 34674040 PMCID: PMC8531187 DOI: 10.1186/s13244-021-01089-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians' knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.
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Affiliation(s)
- Cai-Wei Yang
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Feng Che
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yuan Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bo Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Differentiation between small (< 4.5 cm) true subepithelial tumors and ectopic pancreas in the small bowel on computed tomography enterography. Eur Radiol 2021; 32:1760-1769. [PMID: 34510247 DOI: 10.1007/s00330-021-08252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/23/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To identify imaging features that can differentiate ectopic pancreas from true subepithelial tumors (SETs) in the small bowel using CT enterography and to assess whether radiologists' performance for the differentiation can be improved with the knowledge of significant CT findings. METHODS CT images of ectopic pancreas (n = 29) and pathologically proven SETs (n = 61) were retrospectively reviewed by two radiologists in consensus. CT items analyzed included lesion location, contour (round, ovoid, flat/conformed), growth pattern, margin, homogeneity, necrosis, feeding vessel, surface ulceration, and enhancement pattern. For quantitative analysis, Hounsfield unit, longer diameter (LD), and shorter diameter (SD) of the lesion were measured. Univariate and multivariate analyses were performed. Diagnostic performance for differentiating ectopic pancreas from SETs was independently evaluated by two other radiologists using a receiver operating characteristic analysis. RESULTS Age < 63 years, female sex, flat/conformed appearance, homogeneous enhancement, the absence of feeding vessels and necrosis, and an LD/SD ratio > 1.5 were significant variables for differentiating ectopic pancreas from small bowel SETs (p < 0.05). In the multivariate analysis, flat/conformed appearance, the absence of feeding vessels, and female sex remained suggestive features for ectopic pancreas. Area under the curve values for differentiating between two disease entities increased by both independent reviewers with knowledge of these significant CT features. CONCLUSIONS Ectopic pancreas in the small bowel can be effectively differentiated from small (< 4.5 cm) true SETs by a flat/conformed appearance and the absence of feeding vessels on CT enterography. In addition, radiologists' performance for differentiating ectopic pancreas from small bowel SETs was improved with the knowledge of these significant CT findings. KEY POINTS • Ectopic pancreas in the small bowel can be differentiated from small (< 4.5 cm) subepithelial tumors on CT. • Differential CT findings of the ectopic pancreas are a flat or conformed appearance and the absence of a feeding vessel. • Radiologists' performance for differentiating ectopic pancreas from small bowel SETs can be improved with the knowledge of differential CT findings.
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Marín-Díez E, Crespo Del Pozo J. Diagnostic approach to small-bowel wall thickening: beyond Crohn's disease and cancer. RADIOLOGIA 2021; 63:S0033-8338(21)00016-3. [PMID: 33546910 DOI: 10.1016/j.rx.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/13/2020] [Accepted: 11/26/2020] [Indexed: 11/24/2022]
Abstract
Although small-bowel wall thickening is a common manifestation of Crohn's disease and tumors, many other entities can give rise to similar imaging findings. The small bowel is difficult to access by endoscopy, so radiologic imaging tests play an essential role in the diagnosis of conditions involving the small bowel. The main objectives of this paper are to explain the definition of small-bowel wall thickening, analyze the patterns of involvement seen in multidetector computed tomography (MDCT) with intravenous contrast administration, and provide an image-based review of the different causes of small-bowel wall thickening. The differential diagnosis must include many entities because wall thickening can result from immune-mediated, infectious, or vascular causes, as well as from toxicity and other lesser-known entities. As the imaging appearance of many of these conditions overlap, clinical and laboratory findings are necessary to support the imaging diagnosis.
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Affiliation(s)
- E Marín-Díez
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J Crespo Del Pozo
- Servicio de Radiodiagnóstico, Hospital Universitario Marqués de Valdecilla, Santander, España
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10
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Yang CW, Liu XJ, Wei Y, Wan S, Ye Z, Yao S, Zeng N, Cheng Y, Song B. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol (NY) 2021; 46:168-178. [PMID: 32613400 DOI: 10.1007/s00261-020-02631-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To determine whether morphologic features and semiquantitative parameters of computed tomography (CT) could be used to distinguish heterotopic pancreas from gastrointestinal stromal tumor (GIST) and leiomyoma. METHODS This retrospective study evaluated CT images of heterotopic pancreases (n = 28), GISTs (n = 57), and leiomyomas (n = 26) located in the upper gastrointestinal tract. Morphologic imaging features of lesions were analyzed, including location, contour, margin, attenuation, growth pattern, enhancement type, enhancement degree, enlarged vessels feeding or draining the mass, hyperenhancement of the overlying mucosa, low intralesional attenuation, calcification, and a duct-like structure. Semiquantitative parameters included long diameter (LD), short diameter (SD), LD/SD ratio, and lesion and aorta CT values during plain CT (Lp and Ap), arterial phase (La and Aa), and venous phase (Lv and Av). Diagnostic performance of these findings and parameters were evaluated by receiver operating characteristic (ROC) analysis. RESULTS Morphologic CT findings (including lesion contour, margin, attenuation, growth pattern, enhancement type, and enhancement degree) and semiquantitative parameters except for LD/SD were demonstrated to be significant for differentiating heterotopic pancreas from GIST and leiomyoma (all P < 0.01). Of these, location, low intralesional attenuation, duct-like structure and LD, SD, Lv, and Sv values showed good diagnostic performance with the areas under curve (AUC) higher than 0.70. The presence of a duct-like structure demonstrated the best diagnostic ability with AUC of 0.929 [95% confidence interval (CI) 0.864-0.969], sensitivity of 5.7% (95% CI 67.3-96.0), and specificity of 100% (95% CI 95.7-100), respectively. When the three morphologic features (location, low intralesional attenuation, duct-like structure) were used in combination, the AUC was improved to 0.980 (95% CI 0.952-1). CONCLUSION CT features, especially the morphologic features, could be used to differentiate heterotopic pancreas from GIST and leiomyoma in the upper gastrointestinal tract and, thus, provide a more accurate method for non-invasive preoperative diagnosis. Additionally, the presence of a duct-like structure demonstrated to be a reliable indicator for heterotopic pancreas among the morphologic and semiquantitative CT features.
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Affiliation(s)
- Cai-Wei Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xi-Jiao Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Shan Yao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ni Zeng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yue Cheng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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11
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Persano G, Cantone N, Pani E, Ciardini E, Noccioli B. Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature. Ital J Pediatr 2019; 45:142. [PMID: 31706342 PMCID: PMC6842505 DOI: 10.1186/s13052-019-0738-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 10/23/2019] [Indexed: 12/15/2022] Open
Abstract
Background Heterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding. Patients and methods The clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined. Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly. Results Fourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected. Conclusion Heterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy. Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.
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Affiliation(s)
- Giorgio Persano
- Department of Pediatric Surgery, IRCCS Gaslini, via Gerolamo Gaslini, 5, 16147, Genoa, Italy.
| | - Noemi Cantone
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
| | - Elisa Pani
- School of Pediatric Surgery, University of Genoa, Italy - Department of Pediatric Surgery, Meyer Children's Hospital, Florence, Italy
| | - Enrico Ciardini
- Department of Pediatric Surgery, District Hospital, Trento, Italy
| | - Bruno Noccioli
- Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy
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Li LM, Feng LY, Chen XH, Liang P, Li J, Gao JB. Gastric heterotopic pancreas and stromal tumors smaller than 3 cm in diameter: clinical and computed tomography findings. Cancer Imaging 2018; 18:26. [PMID: 30086800 PMCID: PMC6081935 DOI: 10.1186/s40644-018-0161-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/29/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Identifying gastric heterotopic pancreas and stromal tumors is difficult. Few studies have reported computed tomography (CT) findings for differentiating lesions less than 3 cm in diameter. In this study, we aimed to identify clinical characteristics and CT findings that can differentiate gastric heterotopic pancreatic lesions from stromal tumors less than 3 cm in diameter. METHODS A total of 132 patients with pathologically confirmed gastric heterotopic pancreas (n = 66) and stromal tumors (n = 66) were included. Each group was divided into primary (n = 50) and validation cohort (n = 16). Clinical characteristics and CT findings were retrospectively reviewed. CT findings included location, border, contour, growth pattern, enhancement pattern and grade, the enhancement value of tumor, enhancement ratio of tumor, and enhancement ratio of tumor to pancreas in venous phase. The findings in the two groups were compared using the Pearson χ2 test or Student t-test. Receiver operating characteristic curves were used to determine areas under the curve and optimal cut-offs. RESULTS Significant differences were observed between heterotopic pancreas and stromal tumors in the distribution of tumor location, border, contour (all P < 0.001), enhancement values (P < 0.001), enhancement ratios of tumors (P < 0.001), and enhancement ratios of tumors to pancreas (P < 0.001). No significant differences existed in growth pattern (P = 0.203). The area under the curve differed significantly between enhancement ratio of tumor to pancreas and enhancement ratio (P = 0.030). There were significant differences in above characteristics between two groups in validation cohort. CONCLUSIONS Heterotopic pancreas has characteristic CT features differentiating it from stromal tumors.
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Affiliation(s)
- Li-Ming Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Lei-Yu Feng
- Department of Internal Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Xiao-Hua Chen
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Pan Liang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jing Li
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China
| | - Jian-Bo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan Province, China.
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Heterotopic pancreas of the jejunum: associations between CT and pathology features. ACTA ACUST UNITED AC 2015; 40:38-45. [PMID: 24934475 DOI: 10.1007/s00261-014-0177-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the computed tomography (CT) features of heterotopic pancreas of the jejunum (HPJ) and to assess their associations with HPJ pathology features. METHODS In this retrospective series analysis, two radiologists reviewed the CT images of 17 patients with surgically proven HPJ in order to determine in consensus the location, long diameter, margin, shape, contour, and growth pattern of the lesions, the presence of a duct-like structure, the lesion enhancement patterns, including the homogeneity, and the degree of contrast enhancement compared with that of the main pancreas. The pathology features of the surgical specimens were reviewed and their associations with the CT features were assessed. RESULTS On CT, the HPJs typically appeared as a small (<3 cm), well-defined, ovoid or flat-shaped mass in the proximal jejunum with multiple and tiny lobulations. The growth pattern varied and the duct-like structure was rarely visible. The HPJs mostly appeared to be homogeneous and exhibited hyper- or isoattenuation compared to the main pancreas in the arterial and portal phases. However, these enhancement patterns varied slightly depending on the microscopic composition of the lesions (i.e., acinar vs. ductal predominance). Most HPJs comprised histologically of large acini, some ducts, and small islet cells, and had ductal communication with the jejunum. CONCLUSIONS HPJs typically manifested as small, well-defined, ovoid or flat-shaped, homogeneous, and well-enhancing masses with a microlobulated contour in the proximal jejunum on CT, and their enhancement patterns associated with their microscopic composition. The pathology features of HPJs generally mimic those of the normal pancreas.
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14
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Alessandrino F, Souza D, Ivanovic AM, Radulovic D, Yee EU, Mortele KJ. MDCT and MRI of the ampulla of Vater (part II): non-epithelial neoplasms, benign ampullary disorders, and pitfalls. ACTA ACUST UNITED AC 2015; 40:3292-312. [DOI: 10.1007/s00261-015-0529-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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15
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Endosonographic features of histologically proven gastric ectopic pancreas. Gastroenterol Res Pract 2014; 2014:160601. [PMID: 25371670 PMCID: PMC4209789 DOI: 10.1155/2014/160601] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/19/2014] [Accepted: 09/07/2014] [Indexed: 12/13/2022] Open
Abstract
Gastric ectopic pancreas is an uncommon developmental anomaly and its histological diagnosis is usually difficult by using a conventional biopsy forceps. In the literature, most cases of gastric ectopic pancreas were usually diagnosed by gross pattern during endoscopic examination or features of endoscopic ultrasound. In contrast, this disease was seldom diagnosed by histology in clinical practice. Although the typical endoscopic ultrasonographic features of ectopic pancreas include heterogeneous echogenicity, indistinct borders, and a location within 2 or more layers, it can also exhibit hypoechoic homogeneous echogenicity and a distinct border within the fourth sonographic layer (muscularis propria) similar to the endoscopic ultrasonographic features of gastrointestinal stromal tumors. In our study, we found that 53% of gastric ectopic pancreas originated within the fourth sonographic layer, demonstrating hypoechoic, homogeneous echogenicity, and distinct borders. Therefore, recognizing endoscopic ultrasonographic features, combining with deep biopsy, endoscopic ultrasound-guided fine needle aspiration/core needle biopsy can prevent conducting unnecessary resection. Surgical resection is the mainstay treatment for symptomatic gastric ectopic pancreas, but endoscopic resection using endoscopic mucosal resection or endoscopic submucosal dissection technique provides an alternative method of removing superficial-type and deep-type gastric ectopic pancreas.
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16
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A case of gastric plexiform fibromyxoma: radiological and pathological findings. Jpn J Radiol 2014; 32:431-6. [PMID: 24744134 DOI: 10.1007/s11604-014-0315-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 04/01/2014] [Indexed: 12/14/2022]
Abstract
Plexiform fibromyxoma is a relatively new pathological category that consists of a rare group of non-gastrointestinal stromal tumors with a peculiar plexiform growth pattern. We report a case of gastric plexiform fibromyxoma in a 60-year-old man. Gastroscopic examination revealed a gastric submucosal tumor in the antrum. Magnetic resonance imaging (MRI) showed a nodule with distinct signal hyperintensity on T2-weighted images, with strong enhancement peripherally in the early phase to the entire lesion in the delayed phase. Endoscopic ultrasound-guided fine-needle aspiration cytology was performed, and the cytological diagnosis was spindle cell tumor, so partial gastrectomy was performed under a preoperative diagnosis of GIST. The resected tumor demonstrated plexiform architecture, myxoid stroma, prominent vasculature, and spindle cells, reflecting the characteristic findings on MRI. This is the first report to describe radiological findings for gastric plexiform fibromyxoma.
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