Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma

Yang, Caiwei; Liu, Xi-Jiao; Yi, Wei; Wan, Shang; Zheng, Yi; Yao, Shan; Zeng, Ni; Cheng, Yue; Song, Bin

doi:10.1007/s00261-020-02631-2

Cited by 8 publications

(29 citation statements)

References 27 publications

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“…Nevertheless, previous studies didn't make usage of receiver operating characteristic analysis to determine the diagnostic performance of contrast-enhanced CT. Later, studies filled the gap by addressing the shortcoming, though lack of pathologic to radiologic correlation [31,32,41]. Compared to Kim et al 's study, Yang et al [31] not only individualized CT attenuation by using the Fig. 6 a, b Coronal and axial enhanced CT images of a heterotopic pancreas in the duodenum of a 53-year-old male showed a 1.3 cm × 0.9 cm, endoluminal lesion (white arrows) with a lobulated margin, presenting round contour on axial image while flat pattern on coronal CT image.…”

Section: Contrast-enhanced Computed Tomographymentioning

confidence: 99%

“…GHP often presents as an intramural oval mass with indistinct margins on CT coronal images [ 23 , 30 ]. GHP is usually small in diameter (often less than 3 cm) and tends to be an intraluminal growth pattern [ 6 , 14 , 31 , 32 ]. The CT attenuation, enhancement heterogeneity, and enhancement degree of GHP correlate with its pathological histological compositions [ 5 , 9 , 10 , 14 , 23 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

“…Rather, a study indicated that coronal and sagittal observation based on three-dimensional reconstruction may improve the characteristic sign detection of “a duct-like structure” (Fig. 6 ) [ 31 ]. GHP in the jejunum shares many same imaging features as those in the stomach and duodenum, but there are a few disparities: (a) while “central umbilical sign” and hyperenhancement of underlying mucosa of adjacent gastrointestinal wall can occasionally be observed in the gastric and duodenal lesion, both are rare in the jejunal lesion [ 23 ], (b) GHP in the stomach or duodenum manifest endoluminal growth pattern predominantly, whereas no dominant growth pattern was found in jejunal lesion: endoluminal, exophytic, and mixed growth patterns were all distributed [ 23 ], (c) “a duct-like structure” sign in the jejunal lesion is relatively more difficult to identify than that in the gastric lesion [ 10 , 23 ], and a study found that only three cases (3/16, 19%) of jejunal lesions were observed “a duct-like structure” signs on CT images [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, previous studies didn’t make usage of receiver operating characteristic analysis to determine the diagnostic performance of contrast-enhanced CT. Later, studies filled the gap by addressing the shortcoming, though lack of pathologic to radiologic correlation [ 31 , 32 , 41 ]. Compared to Kim et al’s study, Yang et al [ 31 ] not only individualized CT attenuation by using the lesion to aorta ratio method, but also combined significant variables in univariate analysis and achieved higher area under the curve values.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

et al. 2021

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Heterotopic pancreas (HP) is an uncommon congenital abnormality in the developmental process of the pancreas, with gastrointestinal heterotopic pancreas (GHP) being the most common HP. The clinical manifestations of GHP may have variable patterns of presentation, dictated by both the anatomic location and the functional ability of the lesion. The most common imaging modality in detecting GHP is computed tomography (CT), while gastrointestinal barium fluoroscopy, endoscopic ultrasonography, and magnetic resonance imaging (MRI) are also applied. The density and enhancement patterns of GHP are consistent with histological classifications. GHP with a predominantly acinar tissue component manifests homogeneous and marked enhancement on CT images, whereas a predominantly ductal GHP presents heterogeneous and mild enhancement. On MRI, the appearance and signal intensity of GHP were paralleled to the normal pancreas on all sequences and were characterized by T1-weighted high signal and early marked enhancement. This article provides a comprehensive review of the histopathology, clinical manifestations, imaging features of various modalities, and differential diagnosis of GHP. It is hoped that this review will improve clinicians’ knowledge of GHP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate.

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Section: Contrast-enhanced Computed Tomographymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

et al. 2021

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Extensive heterotopic pancreas in a rare site: A case report and a review of literature

et al. 2023

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Rationale: Heterotopic pancreas is a pancreatic tissue that occurs outside the normal anatomical site, the most common site is antrum. Due to the lack of specific imaging and endoscopic signs, heterotopic pancreas especially those occurring in the rare site, are often misdiagnosed, and leading to unnecessary surgical treatment. Endoscopic incisional biopsy and endoscopic ultrasound-guided fine-needle aspiration are effective means for diagnosing heterotopic pancreas. We reports a case of extensive heterotopic pancreas in a rare site, which was finally diagnosed by this way. Patient concerns: A 62-year-old man was admitted due to the presence of an angular notch lesion, which was suspected as gastric cancer before. He denied any history of tumor or gastric disease. Diagnoses: No abnormality was found in the physical examination and laboratory testing after admission. Computed tomography showed localized thickening of the gastric wall measuring 30 mm in the long diameter. Gastroscope revealed a nodular-like submucosal protuberance at the angular notch with size of about 3*4 cm. Ultrasonic gastroscope showed that the lesion was located in the submucosa. The lesion exhibited mixed echogenicity. The diagnosis can not be identified. Interventions: 2 times of incision biopsy were performed to make a clear diagnosis. Finally, appropriate tissue specimens were obtained for pathology testing. Outcomes: The patient was diagnosed as heterotopic pancreas according to pathology. He was recommended to undergo observation and regular follow-ups rather than surgery. Then he was discharged home with no discomfort. Lessons: Heterotopic pancreas occurring in the angular notch is extremely rare, the site is scarcely reported in the relevant literature. Therefore, it is easy to be misdiagnosed. In the cases of an vague diagnosis, endoscopic incisional biopsy or endoscopic ultrasound-guided fine-needle aspiration may be a good choice.

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Pancreatic Heterotopia in the Small Bowel

Chin¹,

Chen³

et al. 2022

Pancreas

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Diagnosing pancreatic heterotopia (PH) is challenging, because it is a rare congenital anomaly. We report the case of a 66-year-old man who presented with ileus and jejunal PH diagnosed using single-balloon enteroscopy. Reviewing 178 cases of small intestinal PH in the literature showed that (1) PH mostly occurred at the duodenum (61.8%), followed by the jejunum (22.5%) and ileum (14.6%); (2) patients with ileal PH were younger (mean, 40.7 vs 54.6 years; P < 0.001), while those with jejunal PH were older (mean, 59.5 vs 51.7 years; P = 0.006); (3) most patients with jejunal PH were females, while those with duodenal or ileal PH were predominantly males (M:F = 0.8:1 vs 2.5:1; P = 0.003); (4) asymptomatic cases were rare (15.2% vs 83.4% in small and nonsmall bowel, respectively); (5) most patients with ileal PH presented with bleeding (61.5%), while the remaining had abdominal pain (42.8%); (6) emergent operation was performed in 11 cases (6.2%), mainly at the jejunum (12.5%) and Meckel’s diverticulum (25%); and (7) Heinrich’s classification may be inconclusive. Enteroscopy was performed in only 6 cases (3.4%), and earlier diagnosis and further minimally invasive procedures could have been achieved with enteroscopy.

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Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma

Cited by 8 publications

References 27 publications

Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

Extensive heterotopic pancreas in a rare site: A case report and a review of literature

Pancreatic Heterotopia in the Small Bowel

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