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      Heterotopic Pancreas: Histopathologic Features, Imaging Findings, and Complications

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          Abstract

          Heterotopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separate from the main gland. The most common locations of this displacement include the upper gastrointestinal tract-specifically, the stomach, duodenum, and proximal jejunum. Less common sites are the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Uncomplicated heterotopic pancreas is typically asymptomatic, with the lesion being discovered incidentally during an unrelated surgery, during an imaging examination, or at autopsy. The most common computed tomographic appearance of heterotopic pancreas is that of a small oval intramural mass with microlobulated margins and an endoluminal growth pattern. The attenuation and enhancement characteristics of these lesions parallel their histologic composition. Acinus-dominant lesions demonstrate avid homogeneous enhancement after intravenous contrast material administration, whereas duct-dominant lesions are hypovascular and heterogeneous. At magnetic resonance imaging, the heterotopic pancreas is isointense to the orthotopic pancreas, with characteristic T1 hyperintensity and early avid enhancement after intravenous gadolinium-based contrast material administration. Heterotopic pancreatic tissue has a rudimentary ductal system in which an orifice is sometimes visible at imaging as a central umbilication of the lesion. Complications of heterotopic pancreas include pancreatitis, pseudocyst formation, malignant degeneration, gastrointestinal bleeding, bowel obstruction, and intussusception. Certain complications may be erroneously diagnosed as malignancy. Paraduodenal pancreatitis is thought to be due to cystic degeneration of heterotopic pancreatic tissue in the medial wall of the duodenum. Recognizing the characteristic imaging features of heterotopic pancreas aids in differentiating it from cancer and thus in avoiding unnecessary surgery. © RSNA, 2017.

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          Most cited references35

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          Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma.

          To describe the computed tomographic (CT) findings of ectopic pancreas and to identify the features that differentiate it from other similarly manifesting gastric submucosal tumors such as gastrointestinal stromal tumor (GIST) and leiomyoma, which are the most common gastrointestinal submucosal tumors. This retrospective study was approved by the institutional review board and did not require informed consent. CT images of pathologically proved ectopic pancreases (n = 14), GISTs (n = 33), and leiomyomas (n = 7) in the stomach and duodenum were retrospectively reviewed. Analysis of the CT findings included evaluation of the location, contour, growth pattern, border, enhancement pattern, and enhancement grade of the tumor, as well as the presence of surface dimpling, prominent enhancement of overlying mucosa, and low intralesional attenuation. The attenuation of each lesion, the long diameter (LD), the short diameter (SD), and the LD/SD ratio were measured. Among these findings, statistically significant variables were determined by using the chi(2) test (to compare the categoric variables), the Student t test (for quantitative analysis), and the receiver operating characteristic curve (to determine the optimal cutoff of the LD/SD ratio). The typical location (prepyloric antrum and duodenum), endoluminal growth pattern, ill-defined border, prominent enhancement of overlying mucosa, and an LD/SD ratio of greater than 1.4 were found to be significant for differentiating ectopic pancreas from other tumors (P < .05 for each finding). When at least two of these five criteria were used in combination, the sensitivity and specificity for diagnosing ectopic pancreas were 100% (14 of 14) and 82.5% (33 of 40), respectively. When four of these criteria were used, a sensitivity of 42.9% and a specificity of 100% were achieved. By using specific CT criteria, ectopic pancreas can be differentiated from small GIST or leiomyoma with a high degree of accuracy. (c) RSNA, 2009.
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            From the archives of the AFIP. Meckel diverticulum: radiologic features with pathologic Correlation.

            Meckel diverticulum is the most common congenital anomaly of the gastrointestinal tract, occurring in 2%-3% of the population. It results from improper closure and absorption of the omphalomesenteric duct. Meckel diverticulum is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus, umbilical cyst, and a fibrous cord connecting the ileum to the umbilicus. The formation of Meckel diverticulum occurs with equal frequency in both sexes, but symptoms from complications are more common in male patients. Sixty percent of patients come to medical attention before 10 years of age, with the remainder of cases manifesting in adolescence and adulthood. Heterotopic gastric and pancreatic mucosa are frequently found histologically within the diverticula of symptomatic patients. The most common complications are hemorrhage from peptic ulceration, small intestinal obstruction, and diverticulitis. Although the clinical, pathologic, and radiologic features of the complications of Meckel diverticulum are well known, the diagnosis of Meckel diverticulum is difficult to establish preoperatively.
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              Groove pancreatitis: spectrum of imaging findings and radiology-pathology correlation.

              Groove pancreatitis is a rare form of chronic pancreatitis affecting the "groove" between the pancreatic head, duodenum, and common bile duct. The exact cause is unknown, although there are strong associations with long-term alcohol abuse, functional obstruction of the duct of Santorini, and Brunner gland hyperplasia.
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                Author and article information

                Journal
                RadioGraphics
                RadioGraphics
                Radiological Society of North America (RSNA)
                0271-5333
                1527-1323
                March 2017
                March 2017
                : 37
                : 2
                : 484-499
                Affiliations
                [1 ]From the Department of Radiology, University of Utah, 30 North 1900 East, #1A71, Salt Lake City, UT 84132 (M.R., J.D.O., A.M.S.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); and Department of Radiology, MD Anderson Cancer Center, Houston, Tex (K.M.E.).
                Article
                10.1148/rg.2017160091
                28287935
                a8c3ad2b-2c9d-4964-b2bc-479753e50a1a
                © 2017
                History

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