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Heterotopic pancreas in excluded stomach diagnosed after gastric bypass surgery.

Guimarães M, Rodrigues P, Gonçalves G, Nora M, Monteiro MP - BMC Surg (2013)

Bottom Line: Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management.We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue.A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endocrinology Unit of Hospital São Sebastião, Hospital de São Sebastião, Santa Maria da Feira, Portugal. mpmonteiro@icbas.up.pt.

ABSTRACT

Background: Heterotopic pancreas is defined as finding of pancreatic tissue without anatomic and vascular continuity with the normal pancreas. Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management.

Case presentation: We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue. Before gastric bypass surgery, the presence of the pancreatic mass in the gastric wall was unnoticed in the imagiologic records.

Conclusion: This is the first reported case of pancreatic heterotopy diagnosed in the excluded stomach after gastric bypass. A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research.

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Related in: MedlinePlus

Macroscopic appearance of the subserosal mass at laparoscopy (A) and in the excluded stomach removed after partial gastrectomy (white arrows) (B).
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Figure 2: Macroscopic appearance of the subserosal mass at laparoscopy (A) and in the excluded stomach removed after partial gastrectomy (white arrows) (B).

Mentions: The patient underwent laparoscopic gastrectomy of the excluded stomach for suspected gastrointestinal stromal tumor (GIST) (Figure 2A). Gross examination of the specimen revealed a subserosal polypoid mass in the gastric antrum, which corresponded to a 4.5 cm cystic cavity of greater diameter with creamy yellowish thick content, growing in dependency of the gastric muscular layer (Figure 2B). The histology of the mass showed a flap of gastric wall with antral mucosa and a heterotopic pancreatic cist, while in the adipose tissue of the root of the greater omentum six other yellow and lobulated nodules were identified and dissected. All fragments corresponded histologicaly to pancreatic tissue with normal exocrine and endocrine distribution, as displayed by the immunohistochemistry staining for chromogranin A, insulin and glucagon expressing cells, as well as a low proliferation index as revealed by the Ki-67 staining, which are characteristic of the normal pancreatic tissue (Figure 3, A-F). After gastrectomy, the patient became asymptomatic and so has remained ever since.


Heterotopic pancreas in excluded stomach diagnosed after gastric bypass surgery.

Guimarães M, Rodrigues P, Gonçalves G, Nora M, Monteiro MP - BMC Surg (2013)

Macroscopic appearance of the subserosal mass at laparoscopy (A) and in the excluded stomach removed after partial gastrectomy (white arrows) (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4222587&req=5

Figure 2: Macroscopic appearance of the subserosal mass at laparoscopy (A) and in the excluded stomach removed after partial gastrectomy (white arrows) (B).
Mentions: The patient underwent laparoscopic gastrectomy of the excluded stomach for suspected gastrointestinal stromal tumor (GIST) (Figure 2A). Gross examination of the specimen revealed a subserosal polypoid mass in the gastric antrum, which corresponded to a 4.5 cm cystic cavity of greater diameter with creamy yellowish thick content, growing in dependency of the gastric muscular layer (Figure 2B). The histology of the mass showed a flap of gastric wall with antral mucosa and a heterotopic pancreatic cist, while in the adipose tissue of the root of the greater omentum six other yellow and lobulated nodules were identified and dissected. All fragments corresponded histologicaly to pancreatic tissue with normal exocrine and endocrine distribution, as displayed by the immunohistochemistry staining for chromogranin A, insulin and glucagon expressing cells, as well as a low proliferation index as revealed by the Ki-67 staining, which are characteristic of the normal pancreatic tissue (Figure 3, A-F). After gastrectomy, the patient became asymptomatic and so has remained ever since.

Bottom Line: Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management.We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue.A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research.

View Article: PubMed Central - HTML - PubMed

Affiliation: Endocrinology Unit of Hospital São Sebastião, Hospital de São Sebastião, Santa Maria da Feira, Portugal. mpmonteiro@icbas.up.pt.

ABSTRACT

Background: Heterotopic pancreas is defined as finding of pancreatic tissue without anatomic and vascular continuity with the normal pancreas. Heterotopic pancreas is a rare condition difficult to diagnose and with controversial clinical management.

Case presentation: We describe a 43 year old female patient previously submitted to laparoscopic gastric bypass for primary treatment of morbid obesity; 5 years later, the patient was discovered to have a mass in the antrum of the excluded stomach that was found to be heterotopic pancreatic tissue. Before gastric bypass surgery, the presence of the pancreatic mass in the gastric wall was unnoticed in the imagiologic records.

Conclusion: This is the first reported case of pancreatic heterotopy diagnosed in the excluded stomach after gastric bypass. A putative role of incretin hormones in mediating pancreatic cell hyperplasia of heterotopic pancreatic remnants should be considered an additional hypothesis that requires further research.

Show MeSH
Related in: MedlinePlus