Mucinous Cystic Neoplasm in Heterotopic Pancreas Presenting as Colonic Polyp
Context Pancreatic heterotopia in itself is rare in the colon and to the best of our knowledge a neoplasm arising in a heterotopic tissue in the colon has not been reported. We herein report a pancreatic cystic neoplasm arising from heterotopic pancreatic tissue in colon. Case report A 44-year-old lady presented with a history of lower abdominal colic, associated with mucoid loose stools 10-15 times/day. Fecal occult blood was positive on two occasions. On examination, a vague mass was palpable in the left upper quadrant of abdomen. Colonoscopy showed a polypoid growth at the splenic flexure of colon, which on biopsy was reported to be an inflammatory polyp. She underwent a laparoscopic converted to open left hemicolectomy. Post-operatively she developed a intra-abdominal collection which formed a controlled pancreatic fistula after percutaneous drainage. Histopathology revealed pancreatic heterotopia with pancreatic mucinous cystic neoplasm. Conclusion Despite advances in patient care, preoperative diagnosis of heterotopic pancreas is difficult.
Image: Pedunculated polypoidal mass.
Gray SW, Skandalakis JE. Embryology for Surgeons: The Embryological Basis for the Treatment of Congenital Defects. Philadelphia: WB Saunders, 1972
De Castro Barbosa JJ, Dockerty MB. Pancreatic heterotopia: review of the literature and report of 41 authenticated surgical cases, of which 25 were clinically significant. Surg Gynecol Obstet. 1946 May; 82:527-42. PMID: 21024692 [PubMed - OLDMEDLINE]
Dolan RV, ReMine WH, Dockerty MB. The fate of heterotopic pancreatic tissue: a study of 212 cases. Arch Surg 1974; 109:762-5. PMID: 4420439 [PubMed - indexed for MEDLINE]
Wolloch Y. Heterotopic pancreatic tissue in the gallbladder. Acta Chir Scand. 1986 Aug-Sep; 152:557-8. PMID: 3788403 [PubMed - indexed for MEDLINE]
Curd HH. A histologic study of Meckel’s diverticulum. Arch Surg May 1936:32:506.
Yagnik VD, Patel KB, Patel PA, Mulla FI. Ectopic pancreatic tissue in the cecum. Saudi J Gastroenterol. 2010 Jul-Sep; 16(3): 228 PMID: 20616425 [PubMed - indexed for MEDLINE] PMCID: PMC3003203
Beskin CA. Intralobar enteric sequestration of the lung containing aberrant pancreas. J Thorac Cardiovasc Surg 1961; 41:314.
Jaschke W, Aleksic M, Aleksci D. Heterotopic pancreatic tissue in a bronchogenic cyst: diagnosis and therapy. J Thorac Cardiovasc Surg 1982; 30:58.
Caberwal D, Kogan SJ, Levitt SB. Ectopic pancreas presenting as an umbilical mass. J Pediatr Surg. 1977 Aug; 12(4):593-9. PMID: 894461 [PubMed - indexed for MEDLINE]
Tadataka Yamada. Textbook of Gastroenterology. Fifth edition. Wiley Blackwell, 2009
Von Heinrich H. Ein beitrag zur histologie des sogen: akze- ssotischen pancreas. Virchows Arch Pathol Anat Histopathol 1909; 198: 392-401
Armstrong CP, King PM, Dixon JM, Macleod IB. The clinical significance of heterotopic pancreas in the gastrointestinal tract. Br J Surg. 1981 Jun;68(6):384-7. PMID: 7237066 [PubMed - indexed for MEDLINE]
Hsia CY, Wu CW, Lui WY. Heterotopic pancreas: a difficult diagnosis. J Clin Gastroenterol. 1999 Mar; 28(2): 144-7. PMID: 10078823 [PubMed - indexed for MEDLINE]
Mandal S, Mandal AK. Heterotopic pancreas presenting as a tumour nodule along with perforation and peritontis is rare: report of two cases. ANZ J Surg. 2008 Aug; 78(8): 725 PMID: 18796045 [PubMed - indexed for MEDLINE]
Ah-Soune P, Vitton V, Subtil C, Meunier-Carpentier S, Bonmardion R, Desjeux et al. Ectopic pancreas: an exceptional cause of lower intestinal bleeding with hemorrhagic shock.. Gastroenterol Clin Biol. 2008 Feb; 32(2): 202-4 PMID: 18387431 [PubMed - indexed for MEDLINE]
Stock C, Keutgen XM, Pisapia D, Crawford C, Zarnegar R. Heterotopic Pancreatic Neoplasm Presenting as an Obstructing Mass at the Fourth Portion of the Duodenum. JOP. 2011 May 6; 12(3): 241-317. PMID: 21546699 [PubMed - indexed for MEDLINE]
Teke Z, Zengin NI, Atalay F, Karaman K, Demirbag AE, Akdogan M. A Tumor-Like Lesion Mimicking Mucinous (Colloid) Carcinoma in Heterotopic Pancreas of the Prepyloric Antrum: A Formidable Challenge for Frozen Examination JOP. 2010 May 5; 11(3): 237-43 PMID: 20442519 [PubMed - indexed for MEDLINE]
Yan ML, Wang YD, Tian YF, Lin Y. Adenocarcinoma arising from intrahepatic heterotopic pancreas: a case report and literature review. World J Gastroenterol. 2012 Jun 14; 18(22): 2881-4. PMID: 22719201 [PubMed - indexed for MEDLINE] PMCID: PMC3374996
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