Pham Ngoc Trinh Thi, Nguyen Anh Nguyet Thi, Vo Minh Tri Thi, Pham Minh Duc
aSchool of Medicine and Pharmacy, The University of Danang, Da Nang, Vietnam.
bDepartment of Surgery, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam.
Case Rep Gastroenterol. 2022 Sep 16;16(3):546-551. doi: 10.1159/000526135. eCollection 2022 Sep-Dec.
Heterotopic pancreas is defined as the presence of ectopic pancreatic tissue outside boundaries of the pancreas without vascular and duct system connection with the pancreas. Ectopic locations are mostly found anywhere in the gastrointestinal tract such as the stomach (24-38%), the duodenum (9-36%), and the jejunum (0.5-27%). Clinical manifestations are not specific, vague, and misdiagnosed another digestive disease. Most cases are incidentally detected by histological examination of specimens resected for different pathologies during endoscopy, surgery, or even autopsy. We report a case of a 31-year-old man who admitted to the hospital with the reason of epigastric pain for 3 days. Clinical examination showed mild epigastric tenderness. The past medical history of patient was unremarkable. A submucosal lesion was observed in the first part of the duodenum during endoscopy. Computed tomography and endoscopic ultrasonography findings were suspected to be heterotopic pancreatic tissue. After laparoscopic surgery for biopsy, it was histologically confirmed duodenal ectopic pancreas. It is difficult to differentiate gastrointestinal pancreatic heterotopia from gastrointestinal stromal tumors, leiomyoma, or lymphomas by using endoscopy because ectopic tissue is mostly located in the submucosal layer. In addition, rare cases of ectopic pancreatic tissue transform malignancy. Surgical treatment should be considered to take adequate tissue samples for biopsy or resect the lesions in symptomatic patients. Duodenal pancreatic heterotopia is an uncommon congenital malformation and most patients are asymptomatic. Histological examination is essential to exclude malignant lesions and to have an appropriate treatment.
异位胰腺的定义是在胰腺边界之外存在异位胰腺组织，且与胰腺无血管和导管系统连接。异位位置大多见于胃肠道的任何部位，如胃（24% - 38%）、十二指肠（9% - 36%）和空肠（0.5% - 27%）。临床表现不具特异性、模糊不清，易被误诊为其他消化系统疾病。大多数病例是在内镜检查、手术甚至尸检时，对因不同病理情况切除的标本进行组织学检查时偶然发现的。我们报告一例31岁男性患者，因上腹部疼痛3天入院。临床检查显示上腹部轻度压痛。患者既往病史无异常。内镜检查时在十二指肠第一部观察到一个黏膜下病变。计算机断层扫描和内镜超声检查结果怀疑为异位胰腺组织。腹腔镜手术活检后，组织学确诊为十二指肠异位胰腺。由于异位组织大多位于黏膜下层，通过内镜检查很难将胃肠道胰腺异位与胃肠道间质瘤、平滑肌瘤或淋巴瘤区分开来。此外，异位胰腺组织恶变的情况罕见。对于有症状的患者，应考虑手术治疗以获取足够的组织样本进行活检或切除病变。十二指肠胰腺异位是一种罕见的先天性畸形，大多数患者无症状。组织学检查对于排除恶性病变并进行适当治疗至关重要。
