Solid pancreatic hamartoma

Abstract

A case of solid pancreatic hamartoma in a 58-year-old Japanese woman is presented. She had no symptoms, and a pancreatic mass was incidentally found on screening ultrasonography 4 months before admission. The patient was not alcoholic and had no history of pancreatitis. Physical examination and laboratory data were unremarkable. Preoperative imaging demonstrated a nodule in the body of the pancreas, measuring 2.0 cm in maximum diameter, which showed marked delayed enhancement during dynamic CT. The patient underwent a distal pancreatectomy under the preoperative diagnosis of pancreatic endocrine tumor and had an uneventful postoperative course. A well-demarcated solid nodule, 1.9 cm in diameter, was evident in the body of the pancreas. Microscopically, the lesion was composed of non-neoplastic, disarranged acinar cells and ducts embedded in a sclerotic stroma with elongated spindle cells, lacking discrete islets. The stromal spindle cells were immunoreactive for CD34 and CD117. The histological diagnosis was solid hamartoma of the pancreas. There was no recurrence 5 months after surgery. Herein is reported a case of solid hamartoma of the pancreas and review of the literature. A search through the literature found only two cases of solid hamartoma of the pancreas, among the 14 cases previously reported as pancreatic hamartoma.

Multiple solid pancreatic hamartomas: A case report and review of the literature

“…Thus, hamartoma seems to be a malformation rather than a true neoplasm. To our knowledge, 17 cases of pancreatic hamartoma have been reported so far in the English literature, and the present case is the 18th [1][2][3][4][5][6][7][8][9][10][11][12] . In 2005, Pauser et al [9] divided pancreatic hamartomas into two subgroups: solid and cystic lesions and solid lesions, and the authors reported two cases of solid hamartoma of the pancreas as a cellular hamartoma resembling a gastrointestinal stromal tumor.…”

“…They described the main features of the tumors as focally exocrine and endocrine tissue elements with stromal cells with coexpression of CD34, CD117, and bcl-2 [9] . When we reviewed the cases reported as pancreatic hamartomas to reclassify them into two subgroups and identify the solid pancreatic hamartomas among them, we excluded the cases with evidence of chronic pancreatitis, according to the criteria of pancreatic hamartoma, because chronic pancreatitis with depletion of acinar cells in the fibrous stroma mimicked hamartomas lacking acinar cells in Pauser et al [9] and Nagata et al 10] . Especially for multiple mass-forming lesions of the pancreas, we should consider the possible diagnosis of chronic alcoholic pancreatitis (CAP) and pancreatitis of unknown etiology more carefully than for solitary mass lesions because the fibrosis of CAP and pancreatitis of unknown etiology have been shown to be dense in the interlobular or perilobular areas, not uniformly distributed, and having multinodular cirrhosis-like appearances [16] .…”

“…Of the 17 cases of pancreatic hamartoma, 5 cases seemed to fit the criteria of solid pancreatic hamartoma [1,3,9,10] . In 1977, Anthony et al reported three cases of pseudotumors of the pancreas.…”

“…Pancreatic hamartomas are divided into two subgroups: solid and cystic lesion and solid lesion [9] . Including the cases reported by Pauser et al [9] and Nagata et al [10] , only three cases of solitary solid pancreatic hamartoma have been reported in the English literature, and the etiology of hamartoma remains unknown.…”

“…Non-neoplastic tumor-like lesions in the pancreas are uncommon and include hamartoma [1][2][3][4][5][6][7][8][9][10][11][12] . Mass-forming pancreatitis which is associated with autoimmune pancreatitis, congenital arteriovenous malformation, intra-pancreatic accessory spleen, and others [13,14] .…”