Subramanian M, Wee E, Desai V, Peh WC
Correspondence: Prof Wilfred CG Peh, Wilfred.peh@gmail.com
ABSTRACT
A 46-year-old man presented with right loin tenderness following a road traffic accident. Computed tomography and magnetic resonance imaging showed a well-defined, smooth, enhancing oval lesion in the wall of the first part of the duodenum. The lesion was seen separately from the normal pancreas. It showed attenuation, intensity and enhancement similar to that of normal pancreas. Based on the imaging appearance, a diagnosis of ectopic pancreas was made. The patient underwent oesophagogastroduodenoscopy, endoscopic ultrasonography and fine-needle aspiration cytology of the lesion, which confirmed ectopic pancreatic tissue. Since the patient was asymptomatic, surgical resection was deferred. The embryologic origin, various locations, imaging appearance and clinical significance of ectopic pancreas are discussed.
Keywords: ectopic pancreas, pancreatic heterotopia, pancreatic mass, pancreatic pseudolesion
Singapore Med J 2014; 55(12): 629-634; http://dx.doi.org/10.11622/smedj.2014175
REFERENCES
1. Lai EC, Tompkins RK. Heterotopic pancreas. Review of a 26 year experience. Am J Surg 1986; 151:697-700. http://dx.doi.org/10.1016/0002-9610(86)90045-0 | ||||
2. Mortelé KJ, Rocha TC, Streeter JL, Taylor AJ. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics 2006; 26:715?31. http://dx.doi.org/10.1148/rg.263055164 | ||||
3. Lee WT, Tseng HI, Lin JY, Tsai KB, Lu CC. Ectopic pancreatic tissue presenting as an umbilical mass in a newborn: a case report. Kaohsiung J Med Sci 2005; 21:84-7. http://dx.doi.org/10.1016/S1607-551X(09)70282-7 | ||||
4. Lin LH, Ko SF, Huang CC, et al. Retroperitoneal ectopic pancreas: imaging findings. Br J Radiol 2009; 82:253-5. http://dx.doi.org/10.1259/bjr/27696141 | ||||
5. Karahan OI, Kahriman G, Soyuer I, Arti? T, Comu NB. MR cholangiopancreatography findings of heterotopic pancreatic tissue in the distal common bile duct. Diagn Interv Radiology 2006; 12:180-2. PMid:17160801 | ||||
6. Marchevsky AM. Lung tumors derived from ectopic tissues. Semin Diagn Pathol 1995; 12:172-84. PMid:7638449 | ||||
7. Wang W, Li K, Qin W, Sun H, Zhao C. Ectopic pancreas in mediastinum: report of 2 cases and review of the literature. J Thorac Imaging 2007; 22:256?8. http://dx.doi.org/10.1097/01.rti.0000213587.44719.a7 | ||||
8. Zinkiewicz K, Ju?kiewicz W, Zgodzi?ski W, et al. Ectopic pancreas: endoscopic, ultrasound and radiological features. Folia Morphol (Warsz) 2003; 62:205-9. | ||||
9. Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology 2009; 252:92-100. http://dx.doi.org/10.1148/radiol.2521081441 | ||||
10. Yu J, Turner MA, Fulcher AS, Halvorsen RA. Congenital anomalies and normal variants of the pancreaticobiliary tract and the pancreas in adults: part 2, pancreatic duct and pancreas. AJR Am J Roentgenol 2006; 187:1544-53. http://dx.doi.org/10.2214/AJR.05.0774 | ||||
11. Yuan Z, Chen J, Zheng Q, et al. Heterotopic pancreas in the gastrointestinal tract. World J Gastroenterol 2009; 15:3701-3. http://dx.doi.org/10.3748/wjg.15.3701 | ||||
12. Ormarsson OT, Gudmundsdottir I, Mårvik R. Diagnosis and treatment of gastric heterotopic pancreas. World J Surg 2006; 30:1682-9. http://dx.doi.org/10.1007/s00268-005-0669-6 | ||||
13. Gálvez-Valdovinos R, Mendoza-Rodríguez A, Coronado-Perez JH, Santillan EM, Funes-Rodríguez F. Laparoscopic treatment of heterotopic pancreas in the prepyloric region. J Minim Access Surg 2006; 2:224-6. PMid:21234152 PMCid:PMC3016486 |