Clinical impact of duodenal pancreatic heterotopia – Is there a need for surgical treatment?

BMC Surgery

Research Article

Alexander Betzler¹  Carolin Zimmermann¹  Thilo Welsch¹  Jürgen Weitz¹  Marius Distler¹  Soeren T. Mees¹  Josefine Pump¹  Sebastian Schölch¹  Daniela E. Aust² 

[1] Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, TU Dresden, Fetscher Str. 74, 01037, Dresden, Germany;Institute for Pathology, University Hospital Carl Gustav Carus, TU Dresden, Fetscher Str. 74, 01307, Dresden, Germany;

关键词: Pancreatic heterotopia;    Pancreatic resection;    Heinrich’s classification;    Pancreatic cancer;    Chronic pancreatitis;   

DOI  :  10.1186/s12893-017-0250-x

 received in 2016-12-30, accepted in 2017-05-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPancreatic heterotopia (PH) is defined as ectopic pancreatic tissue outside the normal pancreas and its vasculature and duct system. Most frequently, PH is detected incidentally by histopathological examination. The aim of the present study was to analyze a large single-center series of duodenal PH with respect to the clinical presentation.MethodsA prospective pancreatic database was retrospectively analyzed for cases of PH of the duodenum. All pancreatic and duodenal resections performed between January 2000 and October 2015 were included and screened for histopathologically proven duodenal PH. PH was classified according to Heinrich’s classification (Type I acini, ducts, and islet cells; Type II acini and ducts; Type III only ducts).ResultsA total of 1274 pancreatic and duodenal resections were performed within the study period, and 67 cases of PH (5.3%) were identified. The respective patients were predominantly male (72%) and either underwent pancreatoduodenectomy (n = 60); a limited pancreas resection with partial duodenal resection (n = 4); distal pancreatectomy with partial duodenal resection (n = 1); total pancreatectomy (n = 1); or enucleation (n = 1). Whereas 65 patients (83.5%) were asymptomatic, 11 patients (18.4%) presented with symptoms related to PH (most frequently with abdominal pain [72%] and duodenal obstruction [55%]). Of those, seven patients (63.6%) had chronic pancreatitis in the heterotopic pancreas. The risk of malignant transformation into adenocarcinoma was 2.9%.ConclusionsPH is found in approximately 5% of pancreatic or duodenal resections and is generally asymptomatic. Chronic pancreatitis is not uncommon in heterotopic pancreatic tissue, and even there is a risk of malignant transformation. PH should be considered for the differential diagnosis of duodenal lesions and surgery should be considered, especially in symptomatic cases.

【 授权许可】

CC BY   
© The Author(s). 2017