1
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Das D, Gonzalez IA, Yeh MM, Wu TT, Jain D. Ductal hamartoma of the pancreas: A clinicopathologic study. Hum Pathol 2024; 153:105669. [PMID: 39362530 DOI: 10.1016/j.humpath.2024.105669] [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: 06/24/2024] [Revised: 09/27/2024] [Accepted: 09/30/2024] [Indexed: 10/05/2024]
Abstract
BACKGROUND Benign ductular proliferative lesions that resemble hepatic von-Meyenburg Complexes(VMC)/bile duct hamartomas have been noted to occur in the pancreas, but their incidence, clinicopathologic features and pathogenesis remains unknown. We present herein 3 patients that presented as cysts and call them pancreatic ductal hamartomas (PDH). METHODS Three cases of PDH were identified form a multi-institutional collaborative group, and their clinicopathological were reviewed. In addition, we also examined 115 consecutive pancreatic resections at our institutions for the presence of incidental PDHs. RESULTS The lesions were detected in each case during imaging for abdominal symptoms or grossing. The clinical suspicion was intra-ductal pancreatic mucinous cystic neoplasm (IPMN) in each case that led to pancreatectomy. The cyst fluid CEA was elevated in 2 of the patients tested. The patient age and gender were 73/M (case1), 68/F (case2) and 73/M (case3). In case1 besides the larger cystic lesion, numerous tiny lesions (0.1-0.3 cm) were seen throughout the pancreas. In case2 this was the only lesion, while in case3 there was another gastric-type IPMN with high-grade dysplasia. PDH were identified in 5(4.3%) of 115 consecutive pancreatectomy specimens. The PDHs measured 0.1-2.3 cm, and the histology is characterized by proliferation of irregular ductal structures lined by bland flattened to low columnar epithelium, variable cystic change and inspissated luminal secretions. The lining epithelium varied from non-mucinous pancreatico-biliary type to mucinous gastric foveolar-type, with occasional squamous metaplasia. SUMMARY PDH are seen in 4.5% of all pancreatectomy specimens and detected incidentally, but occasionally may become large and/or cystic enough leading to pancreatectomy. Their relationship to pancreatic carcinoma or IPMN remains currently unknown.
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Affiliation(s)
- Debasmita Das
- Steward Medical Group/Good Samaritan Medical Center, 235 N Pearl Street, Brockton, MA, USA
| | - Ivan A Gonzalez
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Matthew M Yeh
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Tsung-Teh Wu
- Mayo Clinic, Division of Pathology, Rochester, MN, USA
| | - Dhanpat Jain
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA.
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2
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Tanigawa M, Koga Y, Naito Y, Yamaguchi H, Iwasaki T, Kohashi K, Ohike N, Hanada K, Higashi M, Komatsu M, Imai H, Yamakita K, Nagakawa T, Okabe Y, Kato S, Noguchi H, Nakayama T, Yasuda M, Kusano H, Akiba J, Oda Y, Yano H. Pancreatic hamartoma: detection of harbouring NAB2-STAT6 fusion gene. Histopathology 2022; 81:319-328. [PMID: 35758200 DOI: 10.1111/his.14703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
AIM Hamartomas in the pancreas are rare and are often histologically and morphologically similar to solitary fibrous tumours (SFTs). We examined the differences between hamartomas and SFTs at the molecular level. METHODS AND RESULTS Thirteen patients histopathologically diagnosed with pancreatic hamartoma were included in the study. We also performed STAT6 immunohistochemistry (IHC), which is used in the diagnosis of SFT. Furthermore, for the three cases in which RNA was extracted, reverse transcription polymerase chain reaction to search for NAB2-STAT6 fusions was used. Macroscopically, 13 patients had well-demarcated tumour lesions. Histologically, no islets of Langerhans were observed in the lesions, acinar tissue and ducts were unevenly distributed, and elastic fibres were not observed around the ducts by Elastica Van Gieson staining. One case contained a lipomatous hamartoma composed mainly of adipose tissue. Seven of the 13 cases demonstrated expression of STAT6 in the nuclei of intervening spindle cells. NAB2-STAT6 fusions were observed in two of the three cases in which RNA was extracted. These two cases also demonstrated STAT6 expression in spindle cells using STAT6 IHC. In one case of lipomatous hamartoma, we did not confirm NAB2-STAT6 fusion or STAT6 expression in STAT6 IHC. CONCLUSION Of the 13 patients histopathologically diagnosed with hamartoma, two demonstrated NAB2-STAT6 fusions, suggesting the existence of pancreatic hamartomas with molecular-level components identical to those of SFT.
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Affiliation(s)
- Masahiko Tanigawa
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Yutaka Koga
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan.,Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | | | - Takeshi Iwasaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Ohike
- Division of Pathology, Shizuoka, Cancer Center, Shizuoka, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Hiroshima, Japan
| | - Michiyo Higashi
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masato Komatsu
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Imai
- Pathology Division, Mie University Hospital, Tsu, Japan
| | - Keisuke Yamakita
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tatsuya Nagakawa
- Department of Gastroenterology, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Yoshinobu Okabe
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Hirotsugu Noguchi
- Department of Pathology, Field of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshiyuki Nakayama
- Department of Pathology, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Jun Akiba
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
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3
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Santana Valenciano Á, Molina Villar JM, Barranquero AG, Sanjuanbenito Dehesa A, Fernández Cebrián JM. Pancreatic hamartoma: A rare and benign cause of pancreatic incidentaloma. Cir Esp 2022; 100:250-254. [PMID: 35431168 DOI: 10.1016/j.cireng.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/15/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Ángela Santana Valenciano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - José Manuel Molina Villar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Alberto G Barranquero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, Spain
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4
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Varlas V, Neagu O, Moga A, Bălănescu R, Bohiltea R, Vladareanu R, Balanescu L. Fetal Pancreatic Hamartoma Associated with Hepatoblastoma-An Unusual Tumor Association. Diagnostics (Basel) 2022; 12:758. [PMID: 35328311 PMCID: PMC8947736 DOI: 10.3390/diagnostics12030758] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
Abdominal tumor masses are a very rare disease in the fetus. The authors present the first reported case of neonatal multicystic adenomatoid hamartoma of the pancreas associated with well-differentiated fetal epithelial subtype hepatoblastoma and reveal clinical, histologic, and imagistic aspects. Case presentation: A 36-week-old female newborn in whom a 25-week ultrasound showed a relatively homogeneous pancreatic echogenic mass (34 × 30 × 55 mm) with compression of the inferior vena cava and retrograde dilation. Postnatal CT showed a giant pancreatic tumor mass (113 × 70 × 60 mm), with areas enhancing contrast and cystic/necrotic areas and a hypodense, hypocaptive nodule of 8 × 6 mm located at segment IV of the liver; thrombosis of the subhepatic segment of the inferior vena cava and both renal veins. Histopathological and immunohistochemical studies confirmed the diagnosis of multicystic pancreatic adenomatoid hamartoma and well-differentiated fetal epithelial subtype hepatoblastoma. Conclusions: Pancreatic hamartoma can be difficult to diagnose (especially prenatal), with or without nonspecific symptoms. The synchronous presence of hepatoblastoma complicated the therapeutic conduct and prognosis of this case, with the diagnosis being confirmed histopathologically and immunohistochemically after liver biopsy.
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Affiliation(s)
- Valentin Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Oana Neagu
- Department of Anatomopathology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Andreea Moga
- Department of Pediatric Surgery, Children Emergency Hospital "Grigore Alexandrescu", 011743 Bucharest, Romania
| | - Radu Bălănescu
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
- Department of Pediatric Surgery, Children Emergency Hospital "Grigore Alexandrescu", 011743 Bucharest, Romania
| | - Roxana Bohiltea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 011171 Bucharest, Romania
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
| | - Radu Vladareanu
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
- Department of Obstetrics and Gynecology, Elias Clinical Hospital, 011461 Bucharest, Romania
| | - Laura Balanescu
- Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, 37 Dionisie Lupu St., 020021 Bucharest, Romania
- Department of Pediatric Surgery, Children Emergency Hospital "Grigore Alexandrescu", 011743 Bucharest, Romania
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5
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Santana Valenciano Á, Molina Villar JM, G Barranquero A, Sanjuanbenito Dehesa A, Fernández Cebrián JM. Pancreatic hamartoma: a rare and benign cause of pancreatic incidentaloma. Cir Esp 2021; 100:S0009-739X(21)00071-3. [PMID: 33785222 DOI: 10.1016/j.ciresp.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Ángela Santana Valenciano
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - José Manuel Molina Villar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Alberto G Barranquero
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España
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6
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Katayama H, Azuma K, Koneri K, Murakami M, Hirono Y, Hatta S, Imamura Y, Goi T. A typical case of resected pancreatic hamartoma: a case report and literature review on imaging and pathology. Surg Case Rep 2020; 6:107. [PMID: 32448918 PMCID: PMC7246275 DOI: 10.1186/s40792-020-00869-y] [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: 03/24/2020] [Accepted: 05/11/2020] [Indexed: 12/30/2022] Open
Abstract
Background Pancreatic hamartomas are rare entities and difficult to diagnose before resection. We report a case of resected pancreatic hamartoma and literature review of typical characteristics of the lesion. Case presentation A 78-year-old man presented with a mass in his pancreas, which was incidentally identified when he experienced pneumonia. No remarkable symptoms were observed, and laboratory tests showed no abnormalities, except a slight carcinoembryonic antigen elevation. Enhanced computed tomography and magnetic resonance imaging showed a well-demarcated solid mass with heterogeneous contrast that was 2 cm in size. A gradual enhancement pattern was also observed. The biopsy revealed no specific findings; therefore, surgical resection was necessitated to confirm the diagnosis. Histopathologically, ducts, acinar cells, and adipose cells without atypia were observed among abundant fibrous stroma, but islets of Langerhans and peripheral nerves were absent. An immunohistochemical examination demonstrated CD34 and c-kit positive staining in the stromal cells, S-100 positivity in the adipose cells, and a lack of elastic fibers in the duct walls. The lesion was diagnosed as a pancreatic hamartoma. Conclusion Asymptomatic pancreatic hamartomas can avoid resection. A careful consideration of imaging and appropriate immunohistochemistry of biopsy specimen may facilitate accurate diagnosis before resection. Therefore, sufficient recognition of the characteristics of pancreatic hamartomas is desirable.
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Affiliation(s)
- Hokahiro Katayama
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan.
| | - Kyohei Azuma
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Kenji Koneri
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Makoto Murakami
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Yasuo Hirono
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Satomi Hatta
- Department of Pathology, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Yoshiaki Imamura
- Department of Pathology, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
| | - Takanori Goi
- 1st Department of Surgery, University of Fukui, 23-3 Matsuoka Shimoaiduki, Eiheiji-cho, Yoshida-gun, Fukui, Japan
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7
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8
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Abstract
Pancreatic masses consisting of lipomatous components clinically include lipoma, liposarcoma, lipomatous pseudohypertrophy of the pancreas, fat-containing neoplasms such as perivascular epithelioid cell tumor, and malignant neoplasm with lipoid degeneration. We present pancreatic lipomatous hamartoma, which has not been reported hitherto. A solid pancreatic mass was detected from a computed tomographic scan check-up in each of 3 cases of Japanese men. Macroscopically, well-demarcated solid lipomatous masses were detected at the uncus, body, and tail of the pancreas, respectively. Microscopically, the masses predominantly consisted of mature adipocytes with no atypia, but contained characteristics components of pancreatic hamartoma, such as small ducts, a well-preserved acinar structure, and/or fibrous stroma. On the basis of the unique features, lack of islets and absence of periductal elastic fibers, these tumors are a distinct variant of pancreatic hamartoma. Furthermore, high-mobility group AT-hook 2 expression in the fibro-adipocytes of this tumor indicated that these cells are an integral component of the pancreatic lipomatous hamartoma. Consequently, the unique tumors described herein are pancreatic lipomatous hamartoma, which must be discriminated from other lipomatous lesions of the pancreas.
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9
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Han YE, Park BJ, Sung DJ, Kim MJ, Han NY, Sim KC, Cho SB, Kim JY. Computed tomography and magnetic resonance imaging findings of pancreatic hamartoma: A case report and literature review. Clin Imaging 2018; 52:32-35. [PMID: 29906625 DOI: 10.1016/j.clinimag.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 04/22/2018] [Accepted: 06/04/2018] [Indexed: 11/15/2022]
Abstract
Pancreatic hamartoma is a rare benign malformation that resembles a neoplasm and may be mistaken for a malignancy. The imaging findings of pancreatic hamartoma are not well established, as only one radiological case report has been described since 1983. Herein, we discussed a case of pancreatic hamartoma in a 35-year-old woman and conducted a literature review focused on imaging findings and differential diagnosis of pancreatic hamartoma. Increased late enhancement on post-contrast dynamic study and absence of diffusion restriction may be characteristic MR imaging findings of pancreatic hamartoma that may narrow the differential diagnosis of hypervascular pancreatic lesions.
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Affiliation(s)
- Yeo Eun Han
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Beom Jin Park
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
| | - Deuk Jae Sung
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Min Ju Kim
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Na Yeon Han
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Ki Choon Sim
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sung Bum Cho
- Department of Radiology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Joo Young Kim
- Department of Pathology, Anam Hospital, Korea University, College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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10
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Delgado PI, Correa-Medina M, Rojas CP. Pancreatic hamartoma in a premature Trisomy 18 female. AUTOPSY AND CASE REPORTS 2017; 7:26-29. [PMID: 29264327 PMCID: PMC5724052 DOI: 10.4322/acr.2017.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 11/12/2017] [Indexed: 12/23/2022] Open
Abstract
Pancreatic hamartomas are extremely rare tumors in adults and even more so in children. They are lesions characterized by acinar, islet and ductal components found in varying proportions and in a disorganized pattern. We report a case of a premature female with trisomy 18 diagnosed by amniocentesis. The newborn was delivered by cesarean section at thirty-three weeks of gestation and expired within one hour of birth. Postmortem examination exhibited numerous features associated with Trisomy 18 including lanugo on the torso and arms, micrognathia, microstomia, left low-set ear with small flat pinna, closed ear canal, clenched fists with overlapping fingers, rocker-bottom feet, narrow pelvis, large right diaphragmatic hernia and left pulmonary hypoplasia. Microscopic examination of the pancreas revealed an area, 1.2 cm in greatest dimension, with branching ducts and cysts lined by cuboidal epithelium intermingled within primitive mesenchymal proliferation and exocrine glands. The cysts measured up to 0.2 cm and were surrounded by a collarette of proliferating spindle cells as highlighted by Masson's trichrome stain. A diagnosis of pancreatic hamartoma was rendered. A total of thirty-four cases of pancreatic hamartomas have been reported in the literature including twenty-seven in adults, five in children and two in newborns. Our case may be the third pancreatic hamartoma reported in association with Trisomy 18. We recommend that careful examination of the pancreas be performed in individuals with Trisomy 18 to further characterize this lesion as one of the possible abnormal findings associated with this syndrome.
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Affiliation(s)
| | - Mayrin Correa-Medina
- University of Miami, Jackson Memorial Hospital, Department of Pathology. Miami, FL, USA
| | - Claudia P Rojas
- University of Miami, Jackson Memorial Hospital, Department of Pathology. Miami, FL, USA
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11
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Nagano H, Nakajo M, Fukukura Y, Kajiya Y, Tani A, Tanaka S, Toyota M, Niihara T, Kitazono M, Suenaga T, Yoshiura T. A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid FDG uptake mimicking a malignant pancreatic tumor: a systematic case review. BMC Gastroenterol 2017; 17:146. [PMID: 29212451 PMCID: PMC5719573 DOI: 10.1186/s12876-017-0704-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/24/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pancreatic hamartomas are extremely rare and may be misdiagnosed as malignant tumors. We report herein a case of a small, solid-type pancreatic hamartoma. CASE PRESENTATION A 72-year-old female was incidentally detected pancreatic lesion by ultrasonography. Computed tomography and magnetic resonance imaging revealed a 2.0-cm solid lesion. The main pancreatic duct (MPD) was obstructed by the lesion in the head of the pancreas, and the upstream MPD was dilated. 18F-fluorodeoxyglucose (FDG) accumulated avidly in the lesion and increased in FDG intensity from the early to the delayed images. The histopathological studies confirmed the diagnosis of pancreatic hamartoma. Immunohistochemically, the cell membrane of the accessory glands and ducts showed homogeneous expression of glucose transporter type I and hexokinase II. CONCLUSION Pancreatic hamartomas causing dilatation of the MPD are extremely rare, and this appears to be the first case of a hamartoma to take up FDG avidly. It was a rare occurrence and should be noted that pancreatic hamartomas can cause an obstruction of the MPD and show avid FDG uptake, thereby mimicking malignant pancreatic tumors.
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Affiliation(s)
- Hiroaki Nagano
- Departments of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan.
| | - Masayuki Nakajo
- Departments of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Yoshihiko Fukukura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8544, Japan
| | - Yoriko Kajiya
- Departments of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Atsushi Tani
- Departments of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Sadao Tanaka
- Departments of Pathology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Mari Toyota
- Departments of Gastroenterology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Toru Niihara
- Departments of Gastroenterology, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Masaki Kitazono
- Departments of Surgery, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Toyokuni Suenaga
- Departments of Surgery, Nanpuh Hospital, 14-3 Nagata, Kagoshima, 892-8512, Japan
| | - Takashi Yoshiura
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8544, Japan
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12
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Shah U, Goldstein AM, Gee MS, Deshpande V. Case 24-2017. An 8-Month-Old Girl with Fever and an Abdominal Mass. N Engl J Med 2017; 377:574-582. [PMID: 28792868 DOI: 10.1056/nejmcpc1616393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Uzma Shah
- From the Departments of Pediatrics (U.S.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Pediatrics (U.S.), Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Allan M Goldstein
- From the Departments of Pediatrics (U.S.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Pediatrics (U.S.), Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Michael S Gee
- From the Departments of Pediatrics (U.S.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Pediatrics (U.S.), Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
| | - Vikram Deshpande
- From the Departments of Pediatrics (U.S.), Pediatric Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Massachusetts General Hospital, and the Departments of Pediatrics (U.S.), Surgery (A.M.G.), Radiology (M.S.G.), and Pathology (V.D.), Harvard Medical School - both in Boston
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13
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Zhang J, Wang H, Tang X, Jiang Q, Wang C. Pancreatic hamartoma, a rare benign disease of the pancreas: A case report. Oncol Lett 2016; 11:3925-3928. [PMID: 27313718 PMCID: PMC4888126 DOI: 10.3892/ol.2016.4535] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 02/08/2016] [Indexed: 01/28/2023] Open
Abstract
Pancreatic hamartoma is an extremely rare, non-neoplastic, mass-forming lesion that may be mistaken for malignancy, and the pre-operative diagnosis is particularly challenging. The published literature contains only 23 cases of pancreatic hamartoma. The majority of the cases reported patients with a single benign tumor-like disease that received a pancreatectomy. Immunohistochemical findings confirmed the diagnosis following surgery. The current study reports the case of a 53-year-old female who presented to the Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital (Beijing, China), due to abdominal pain. Abdominal magnetic resonance imaging revealed a 22×14-mm mass in the head of the pancreas. The patient was pre-operatively diagnosed with a pancreatic space-occupying lesion, and subsequently underwent a pancreaticoduodenectomy. The post-operative course was uneventful. Histological examination of the resected lesion resulted in a diagnosis of pancreatic hamartoma. There were no signs of recurrence at 55 months post-surgery.
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Affiliation(s)
- Jianwei Zhang
- Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital, Beijing 100021, P.R. China
| | - Hui Wang
- Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital, Beijing 100021, P.R. China
| | - Xiaolong Tang
- Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital, Beijing 100021, P.R. China
| | - Qinglong Jiang
- Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital, Beijing 100021, P.R. China
| | - Chengfeng Wang
- Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Cancer Hospital, Beijing 100021, P.R. China
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Importance of NAB2-STAT6 Fusion in the Diagnosis of Pancreatic Solitary Fibrous Tumor with Hamartoma-Like Features: A Case Report and Review of the Literature. Case Rep Pathol 2015; 2015:149606. [PMID: 26425382 PMCID: PMC4575733 DOI: 10.1155/2015/149606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/24/2015] [Indexed: 01/18/2023] Open
Abstract
We report a case of pancreatic hamartoma-like solitary fibrous tumor which was differentiated from pancreatic hamartoma with the detection of NAB2-STAT6 fusion, a specific mutation for solitary fibrous tumors. A pancreatic well-demarcated solid nodule, 21 × 17 mm, of 82-year-old man was surgically enucleated. Microscopic findings were close to a pancreatic hamartoma that consisted of sparsely distributed pancreatic ducts and acini in heavily collagenized fibrous stroma. Neither islet nor peripheral nerve existed in the tumor. The fibroblastic cells in the stroma were immune-positive for CD34, CD99, and bcl-2. But these expressions were not decisive in the differentiation between solitary fibrous tumor and pancreatic hamartoma, because CD34 was positive for both tumors, and CD99 and bcl-2 expressions were not elucidated in the previous cases of pancreatic hamartomas. Thus, we evaluated NAB2-STAT6 fusion. The fibroblastic cells were positive for STAT6 and sequencing analysis revealed the gene fusion between NAB2 exon 4 and STAT6 exon 2, with which the final diagnos is of solitary fibrous tumor was achieved. In conclusion, detection of NAB2-STAT6 fusion has a great diagnostic value for pancreatic solitary fibrous tumors with hamartoma-like features.
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15
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Kim HH, Cho CK, Hur YH, Koh YS, Kim JC, Kim HJ, Kim JW, Kim Y, Lee JH. Pancreatic hamartoma diagnosed after surgical resection. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:330-4. [PMID: 23166894 PMCID: PMC3491237 DOI: 10.4174/jkss.2012.83.5.330] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/27/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022]
Abstract
A pancreatic hamartoma is a rare benign lesion that may be mistaken for malignancy. A pancreatic hamartoma can present with vague, non-specific symptoms, which can be difficult to diagnose despite modern diagnostic tools. We report here a pancreatic hamartoma diagnosed after surgical resection. A 52-year-old female presented with postprandial abdominal discomfort. Abdominal computed tomography and pancreatic magnetic resonance imaging revealed a 2.2 × 2.5-cm cystic mass in the pancreatic head. The patient underwent a pylorus-preserving pancreaticoduodenectomy. The histopathological and immunohistochemical studies helped make the diagnosis of pancreatic hamartoma. Here, we report a case of pancreatic hamartoma and review the relevant medical literature.
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Affiliation(s)
- Ho-Hyun Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
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16
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Sueyoshi R, Okazaki T, Lane GJ, Arakawa A, Yao T, Yamataka A. Multicystic adenomatoid pancreatic hamartoma in a child: Case report and literature review. Int J Surg Case Rep 2012; 4:98-100. [PMID: 23143293 DOI: 10.1016/j.ijscr.2012.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 10/01/2012] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Pancreatic tumor is a rare condition in children, but reasonably common in adults. Histopathology in children also differs from that in adults, with most cases being pancreatoblastoma, solid pseudopapillary tumor, or pancreatic endocrine tumors. PRESENTATION OF CASE A 14-month-old boy was noticed abdominal distension and referred to our hospital. Laboratory findings revealed leukocytosis and elevation of serum level of C-reactive protein and pancreatic enzymes. Radiological findings at admission were the huge abdominal cyst in abdominal computed tomography. As the levels of pancreatic enzyme elevated synchronous to oral feeding, total parenteral nutrition was needed. Besides radiographically the abdominal lesion changed from multiple large cystic type to multiple microcystic lesion including solid component over time. It was considered different diagnosis was pancreatic blastoma, pancreatic pseudo cyst, and lymphangioma and he was performed operation. The huge multicystic and partially solid tumor arising from the tail of pancreas existed from posterior of stomach to pelvic cavity. The tumor was completely resected without pancreatectomy and residual pancreas can be kept without tumor invasion. Histopathological finding was pancreatic hamartoma. DISCUSSION Pancreatic hamartoma was extremely rare, and only 17 cases were previously reported in the literature. This is the first case that the change of radiographic findings overtime was shown. We reviewed 17 cases (4 cases in children) of pancreatic hamartoma including our case. CONCLUSION Although extremely rare, pancreatic hamartoma should be considered in the differential diagnosis of cystic abdominal mass in children.
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Affiliation(s)
- Ryo Sueyoshi
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
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17
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Kawakami F, Shimizu M, Yamaguchi H, Hara S, Matsumoto I, Ku Y, Itoh T. Multiple solid pancreatic hamartomas: A case report and review of the literature. World J Gastrointest Oncol 2012; 4:202-6. [PMID: 23293730 PMCID: PMC3536843 DOI: 10.4251/wjgo.v4.i9.202] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 07/26/2012] [Accepted: 08/17/2012] [Indexed: 02/05/2023] Open
Abstract
Non-neoplastic tumor-like lesions in the pancreas are uncommon. Here, we present a case of multiple solid pancreatic hamartomas in a 78-year-old Japanese woman. Her computed tomography revealed a pancreatic mass, measuring 1.8 cm in maximum diameter. However, no symptoms were found. She was not an alcoholic and had no history of pancreatitis. The patient underwent a pancreatoduodenectomy, and three well-demarcated solid nodules measuring 1.7 cm, 0.4 cm, and 0.3 cm in diameter were found in the pancreatic head. Microscopically, the lesions were composed of non-neoplastic, disarranged acinar cells and ducts embedded in a sclerotic stroma with elongated spindle cells that lacked discrete islets. The stromal spindle cells were immunoreactive for CD34 and CD117. The histological diagnosis was multiple solid hamartomas of the pancreas. There has been no recurrence 30 mo after surgery. So far, 18 cases of pancreatic hamartoma have been reported in the English literature, including our case. Six out of these 18 cases seemed to fit the criteria of solid pancreatic hamartoma. Although the number of cases was limited, solid pancreatic hamartomas seem to be benign tumor-like lesions, which are found incidentally in healthy middle-aged adults, but occasionally involve the whole pancreas, resulting in a poor prognosis. Solid pancreatic hamartoma was sometimes associated with minor pancreatic abnormality, and multiple small lesions other than the main tumors were detected in a small number of cases. From these findings, one may speculate that solid pancreatic hamartoma could be the result of a malformation during the development of the pancreas.
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Affiliation(s)
- Fumi Kawakami
- Fumi Kawakami, Shigeo Hara, Tomoo Itoh, Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Hyogo 6500017, Japan
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