Jun Sun-Young, Son Dahye, Kim Mi-Ju, Kim Sung Joo, An Soyeon, Park Young Soo, Park Sook Ryun, Choi Kee Don, Jung Hwoon-Yong, Kim Song Cheol, Yook Jeong Hwan, Kim Byung-Sik, Hong Seung-Mo
*Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon †Department of Pathology, SAM Medical Center, Anyang ‡Asan Institute for Life Science, Asan Medical Center Departments of §Pathology ∥Oncology ¶Gastroenterology #Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Am J Surg Pathol. 2017 Jun;41(6):833-848. doi: 10.1097/PAS.0000000000000850.
Heterotopic pancreas (HP) can be detected by accompanying symptoms or incidentally during gastrointestinal (GI) tract tumor resection. We compared clinicopathologic features among 165 resected HPs (57 gastric [35%], 56 duodenal [34%], 30 omental [18%], and 22 jejunal [13%]). Symptomatic HPs (79/135 GI tract wall HPs, 59%) were larger (P=0.05), more common in younger patients and in a gastric location (both P<0.001), and more frequently associated with lymphoid cuffs (P=0.03) than incidentally found HPs. Gastric/jejunal HPs were more frequently symptomatic (P<0.001), deeply located (P=0.03), and associated with lymphoid cuffs (P=0.008) and pancreatic intraepithelial neoplasia/intraductal papillary mucinous neoplasms (PanIN/IPMN; P=0.001) than duodenal HPs. HP was frequently associated with acinar-ductal metaplasias (117/135 GI tract wall HPs, 87%) and PanINs/IPMNs (68/135, 50%); those with PanINs/IPMNs were larger (P<0.001), more frequently located in stomach (P=0.001), had deeper wall involvement (P=0.03), and more often showed infiltrative growth (P<0.001) and lymphoid cuffs (P=0.02). Four HPs containing PanINs abutted adenocarcinomas, all expressing wild-type KRAS and intact SMAD4/DPC4 expression. Thus, symptomatic HP is associated with younger age, larger size, gastric location, and lymphoid cuffs. HPs containing PanINs/IPMNs (usually low grade) are larger and more common in stomach, have deeper wall location, and show infiltrative growth and lymphoid cuffs. Adenocarcinomas are rarely observed adjacent to HPs with PanINs/IPMNs. KRAS mutational and SMAD4/DPC4 immunohistochemical studies can discriminate between adenocarcinoma derived from HP and concurrent adenocarcinoma with HP.
异位胰腺（HP）可通过伴随症状被发现，或在胃肠道（GI）肿瘤切除术中偶然被检测到。我们比较了165例切除的HP的临床病理特征（57例位于胃[35%]，56例位于十二指肠[34%]，30例位于网膜[18%]，22例位于空肠[13%]）。有症状的HP（79/135例胃肠道壁HP，59%）比偶然发现的HP更大（P=0.05），在年轻患者中更常见且多位于胃（两者P<0.001），并且更频繁地伴有淋巴袖套（P=0.03）。胃/空肠HP比十二指肠HP更频繁地出现症状（P<0.001），位置更深（P=0.03），并伴有淋巴袖套（P=0.008）和胰腺上皮内瘤变/导管内乳头状黏液性肿瘤（PanIN/IPMN；P=0.001）。HP常与腺泡-导管化生（117/135例胃肠道壁HP，87%）和PanINs/IPMNs（68/135，50%）相关；伴有PanINs/IPMNs的HP更大（P<0.001），更常位于胃（P=0.001），壁内浸润更深（P=0.03），并且更常表现为浸润性生长（P<0.001）和淋巴袖套（P=0.02）。4例含有PanINs的HP紧邻腺癌，所有腺癌均表达野生型KRAS且SMAD4/DPC4表达完整。因此，有症状的HP与年轻、更大尺寸、胃的位置以及淋巴袖套相关。含有PanINs/IPMNs（通常为低级别）的HP更大且在胃中更常见，壁内位置更深，并表现为浸润性生长和淋巴袖套。在含有PanINs/IPMNs的HP附近很少观察到腺癌。KRAS突变和SMAD4/DPC4免疫组化研究可区分源自HP的腺癌和与HP并存的腺癌。
