Heterotopic pancreatic tissue in the gall bladder neck and lymph node surrounding cystic duct identified during cholecystectomy for chronic calculous cholecystitis: a rare case report from Syria

Al-janabi, Moatasem Hussein; Ismail, Leen; Wassouf, Marah Yousef; Sulaiman, Jamal; Salloum, Rabab; Alshehabi, Zuheir

doi:10.1093/omcr/omac068

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Among the spectrum of causes of CDL, enlargement reactive lymphadenopathy in the context of CC is most common, followed by sinus histiocytosis, metastasis, lymphoma, and TB. Other rare causes include lipid histiocytosis or ectopic tissue from various organs such as the pancreas [7,8].…”

Section: Discussionmentioning

confidence: 99%

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Paridhi,

Bahadur,

Adhlakha

et al. 2024

IJARS

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Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.

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Section: Discussionmentioning

confidence: 99%

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Paridhi,

Bahadur,

Adhlakha

et al. 2024

IJARS

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“…Rarely intranodal mimickers such as benign epithelial inclusions, 7 melanocytic nevi, 8 mechanically displaced epithelium, 9–12 Mullerianosis, 13 or activated mesothelial cells 14,15 can mimic a metastatic tumor, each representing a major diagnostic pitfall potentially leading to overdiagnosis of malignancy. While heterotopic pancreatic parenchyma has been described in lymph nodes, these foci are easily distinguished from metastases as the heterotopic tissue shows multiple lines of differentiation 16,17 . Here, we describe 2 cases of benign, non-neoplastic islet cells within peripancreatic lymph nodes in patients who underwent resection for intraductal papillary mucinous neoplasms, a finding which, in isolation, should not be construed as evidence of a neoplastic or metastatic process.…”

mentioning

confidence: 86%

“…While heterotopic pancreatic parenchyma has been described in lymph nodes, these foci are easily distinguished from metastases as the heterotopic tissue shows multiple lines of differentiation. 16,17 Here, we describe 2 cases of benign, non-neoplastic islet cells within peripancreatic lymph nodes in patients who underwent resection for intraductal papillary mucinous neoplasms, a finding which, in isolation, should not be construed as evidence of a neoplastic or metastatic process.…”

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confidence: 98%

Benign Islet Cells Within Peripancreatic Lymph Nodes

Baraban,

Thompson,

Matoso

et al. 2024

American Journal of Surgical Pathology

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The presence of epithelial cells within lymph node parenchyma is typically indicative of a metastatic malignancy. However, there are rare instances in which non-neoplastic epithelial or epithelioid cells may be found within lymph nodes, either due to aberrant embryologic migration, mechanical displacement, or physiological trafficking. These can potentially lead to serious potential diagnostic pitfalls, as when such situations are encountered by surgical pathologists, there is substantial risk of overdiagnosing these as metastatic malignancy. Herein, we describe 2 cases of benign pancreatic islet cells within peripancreatic lymph nodes, and underscore the potential for misdiagnosis of this phenomenon as foci of metastatic well-differentiated neuroendocrine tumor. The benign nature of these intranodal islet cells was supported by: (1) the absence of a well-differentiated neuroendocrine tumor in the entirely submitted concomitant pancreatic resection specimen and (2) the presence of an admixture of insulin and glucagon expressing cells by immunohistochemistry in a distribution characteristic of non-neoplastic pancreatic islets. Both cases were incidental microscopic findings in pancreatic resections for intraductal papillary mucinous neoplasms that were previously biopsied and showed associated microscopic areas of fibrosis and chronic pancreatitis and thus this phenomenon may be related to mechanical displacement from prior injury and/or biopsy.

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Ectopic pancreatic tissue in a cholecystectomy specimen: A rare incidental pathologic finding

Zaresharifi,

Khalili,

Eftekhari

et al. 2023

Clinical Case Reports

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Ectopic pancreatic tissue is a rare congenital abnormality defined as the abnormal location of pancreatic tissue outside the anatomical site of the pancreas without any anatomical or vascular connection to it, which is often discovered incidentally. This is a case of a 40‐year‐old man who was admitted to our surgical department for emergency cholecystectomy due to acute gangrenous cholecystitis. Preoperative ultrasound imaging was indicative only of multiple stones in the gallbladder. Postoperative histopathological examination revealed an area of wall thickening in the neck region of the gallbladder consists of ectopic pancreatic tissue. We emphasize the role of a precise pathologic examination even in routine surgical specimens such as a cholecystectomy specimen, since no preoperative evaluation can be affirmative of such incidental but momentous histopathologic findings. Anatomical pathologists must be aware of the rare presentation of Ectopic Pancreatic Tissue (EPT) in gallbladder which may masquerade as a malignancy.

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Heterotopic pancreatic tissue in the gall bladder neck and lymph node surrounding cystic duct identified during cholecystectomy for chronic calculous cholecystitis: a rare case report from Syria

Cited by 3 publications

References 9 publications

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Benign Islet Cells Within Peripancreatic Lymph Nodes

Ectopic pancreatic tissue in a cholecystectomy specimen: A rare incidental pathologic finding

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