Imaging manifestations and differential diagnosis of ectopic pancreas_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Caiwei ¹ , ZHAO Lian ¹ ,  LIU Xijiao ¹ , HUANG Zixing ¹ , SONG Bin ^1,2

1. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, P. R. China;
2. People’s Hospital of Sanya, Sanya, Hainan 572000, P. R. China;

Corresponding author：

LIU Xijiao, Email: bless_jiao@163.com

Keywords：

ectopic pancreas; gastrointestinal tract; computed tomography; imaging

DOI：

10.7507/1007-9424.202210015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize the imaging manifestation and identification of ectopic pancreas (EP), so as to improve clinicians and radiologists’ knowledge of EP and aid in accurate preoperative diagnosis, thereby reducing the misdiagnosis rate and avoiding unnecessary surgery. Methods Combined with clinical experience and relevant literatures in recent years, the histopathology, common imaging manifestations and main differential diagnosis of ectopic pancreas were summarized. Results EP is a rare congenital developmental anomaly of pancreas, the most common location is the upper digestive system. At present, the commonly used imaging technology is computed tomography. The imaging findings of ectopic pancreas were similar to those of normal pancreas, and its density and enhancement characteristics were related to its histopathological composition. The specific signs of ectopic pancreas include “central umbilical sign” “ductal structure” and “flat/adherent sign”. Heterotopic pancreas should be differentiated from submucosal tumor of gastrointestinal tract. Conclusions The imaging findings of EP have certain characteristics. For some cases with atypical imaging findings, imaging diagnosis is difficult.

Citation： YANG Caiwei, ZHAO Lian, LIU Xijiao, HUANG Zixing, SONG Bin. Imaging manifestations and differential diagnosis of ectopic pancreas. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(12): 1638-1641. doi: 10.7507/1007-9424.202210015 Copy

1.	Rezvani M, Menias C, Sandrasegaran K, et al. Heterotopic pancreas: histopathologic features, imaging findings, and complications. Radiographics, 2017, 37(2): 484-499.
2.	Wei R, Wang QB, Chen QH, et al. Upper gastrointestinal tract heterotopic pancreas: findings from CT and endoscopic imaging with histopathologic correlation. Clin Imaging, 2011, 35(5): 353-359.
3.	Kung JW, Brown A, Kruskal JB, et al. Heterotopic pancreas: typical and atypical imaging findings. Clin Radiol, 2010, 65(5): 403-407.
4.	Fukino N, Oida T, Mimatsu K, et al. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol, 2015, 21(13): 4082-4088.
5.	崔彦, 吉敏, 周金莲, 等. 异位胰腺的临床特点(附11例报告). 中国普外基础与临床杂志, 2006, 13(6): 712-713.
6.	Wang D, Wei XE, Yan L, et al. Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas. World J Gastroenterol, 2011, 17(33): 3850-3855.
7.	孙菊, 印隆林. 胃肠道异位胰腺的 CT 及 MRI 表现. 中国普外基础与临床杂志, 2019, 26(11): 1346-1349.
8.	Lin YM, Chiu NC, Li AF, et al. Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review. World J Gastroenterol, 2017, 23(14): 2493-2504.
9.	Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics, 2013, 33(6): 1673-1690.
10.	Borghei P, Sokhandon F, Shirkhoda A, et al. Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology, 2013, 266(1): 28-36.
11.	Kim DW, Kim JH, Park SH, et al. Heterotopic pancreas of the jejunum: associations between CT and pathology features. Abdom Imaging, 2015, 40(1): 38-45.
12.	Park E, Kim H, Jung K W, et al. Heterotopic pancreas in omphalomesenteric duct remnant World J Gastroenterol. results in persistent umbilical discharge. Korean J Pathol, 2014, 48(4): 323-326.
13.	Mortelé KJ, Rocha TC, Streeter JL, et al. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics, 2006, 26(3): 715-731.
14.	Trifan A, Târcoveanu E, Danciu M, et al. Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis, 2012, 21(2): 209-212.
15.	Ulrych J, Fryba V, Skalova H, et al. Premalignant and malignant lesions of the heterotopic pancreas in the esophagus: a case report and review of the literature. J Gastrointestin Liver Dis, 2015, 24(2): 235-239.
16.	Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology, 2009, 252(1): 92-100.
17.	Kilman WJ, Berk RN. The spectrum of radiographic features of aberrant pancreatic rests involving the stomach. Radiology, 1977, 123(2): 291-296.
18.	Park SH, Han JK, Choi BI, et al. Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients. Abdom Imaging, 2000, 25(2): 119-123.
19.	Lee NK, Kim S, Kim GH, et al. Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation. Radiographics, 2010, 30(7): 1915-1934.
20.	Kim SH, Kim SH, Kim MA, et al. CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas. Eur Radiol, 2015, 25(7): 1946-1957.
21.	Kim DH, Kim JH, Han S, et al. Differentiation between small (< 4.5 cm) true subepithelial tumors and ectopic pancreas in the small bowel on computed tomography enterography. European Radiology, 2022, 32: 1760-1769.
22.	Okuhata Y, Maebayashi T, Furuhashi S, et al. Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI. Abdom Imaging, 2010, 35(1): 85-87.
23.	中国临床肿瘤学会胃肠间质瘤专家委员会. 中国胃肠间质瘤诊断治疗共识(2017年版). 肿瘤综合治疗电子杂志, 2018, 4(1): 31-43.
24.	Xu D, Si GY, He QZ. Correlation analysis of multi-slice computed tomography (MSCT) findings, clinicopathological factors, and prognosis of gastric gastrointestinal stromal tumors. Transl Cancer Res, 2020, 9: 1787-1794.
25.	Yang CW, Liu XJ, Wei Y, et al. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol, 2021, 46(1): 168-178.
26.	刘曦娇, 杨采薇, 黄子星, 等. CT 及 MRI 在胃肠道间质瘤靶向治疗疗效评价中的应用. 中国普外基础与临床杂志, 2019, 26(10): 1239-1242.
27.	Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
28.	Lee MJ, Lim JS, Kwon JE, et al. Gastric true leiomyoma: computed tomographic findings and pathological correlation. J Comput Assist Tomogr, 2007, 31(2): 204-208.
29.	Choi YR, Kim SH, Kim S, et al. Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT. Eur J Radiol, 2014, 83(2): 250-260.
30.	Yang CW, Che F, Liu XJ, et al. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging, 2021, 12: 144. doi: 10.1186/s13244-021-01089-0.

1. Rezvani M, Menias C, Sandrasegaran K, et al. Heterotopic pancreas: histopathologic features, imaging findings, and complications. Radiographics, 2017, 37(2): 484-499.
2. Wei R, Wang QB, Chen QH, et al. Upper gastrointestinal tract heterotopic pancreas: findings from CT and endoscopic imaging with histopathologic correlation. Clin Imaging, 2011, 35(5): 353-359.
3. Kung JW, Brown A, Kruskal JB, et al. Heterotopic pancreas: typical and atypical imaging findings. Clin Radiol, 2010, 65(5): 403-407.
4. Fukino N, Oida T, Mimatsu K, et al. Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol, 2015, 21(13): 4082-4088.
5. 崔彦, 吉敏, 周金莲, 等. 异位胰腺的临床特点(附11例报告). 中国普外基础与临床杂志, 2006, 13(6): 712-713.
6. Wang D, Wei XE, Yan L, et al. Enhanced CT and CT virtual endoscopy in diagnosis of heterotopic pancreas. World J Gastroenterol, 2011, 17(33): 3850-3855.
7. 孙菊, 印隆林. 胃肠道异位胰腺的 CT 及 MRI 表现. 中国普外基础与临床杂志, 2019, 26(11): 1346-1349.
8. Lin YM, Chiu NC, Li AF, et al. Unusual gastric tumors and tumor-like lesions: Radiological with pathological correlation and literature review. World J Gastroenterol, 2017, 23(14): 2493-2504.
9. Kang HC, Menias CO, Gaballah AH, et al. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics, 2013, 33(6): 1673-1690.
10. Borghei P, Sokhandon F, Shirkhoda A, et al. Anomalies, anatomic variants, and sources of diagnostic pitfalls in pancreatic imaging. Radiology, 2013, 266(1): 28-36.
11. Kim DW, Kim JH, Park SH, et al. Heterotopic pancreas of the jejunum: associations between CT and pathology features. Abdom Imaging, 2015, 40(1): 38-45.
12. Park E, Kim H, Jung K W, et al. Heterotopic pancreas in omphalomesenteric duct remnant World J Gastroenterol. results in persistent umbilical discharge. Korean J Pathol, 2014, 48(4): 323-326.
13. Mortelé KJ, Rocha TC, Streeter JL, et al. Multimodality imaging of pancreatic and biliary congenital anomalies. Radiographics, 2006, 26(3): 715-731.
14. Trifan A, Târcoveanu E, Danciu M, et al. Gastric heterotopic pancreas: an unusual case and review of the literature. J Gastrointestin Liver Dis, 2012, 21(2): 209-212.
15. Ulrych J, Fryba V, Skalova H, et al. Premalignant and malignant lesions of the heterotopic pancreas in the esophagus: a case report and review of the literature. J Gastrointestin Liver Dis, 2015, 24(2): 235-239.
16. Kim JY, Lee JM, Kim KW, et al. Ectopic pancreas: CT findings with emphasis on differentiation from small gastrointestinal stromal tumor and leiomyoma. Radiology, 2009, 252(1): 92-100.
17. Kilman WJ, Berk RN. The spectrum of radiographic features of aberrant pancreatic rests involving the stomach. Radiology, 1977, 123(2): 291-296.
18. Park SH, Han JK, Choi BI, et al. Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients. Abdom Imaging, 2000, 25(2): 119-123.
19. Lee NK, Kim S, Kim GH, et al. Hypervascular subepithelial gastrointestinal masses: CT-pathologic correlation. Radiographics, 2010, 30(7): 1915-1934.
20. Kim SH, Kim SH, Kim MA, et al. CT differentiation of poorly-differentiated gastric neuroendocrine tumours from well-differentiated neuroendocrine tumours and gastric adenocarcinomas. Eur Radiol, 2015, 25(7): 1946-1957.
21. Kim DH, Kim JH, Han S, et al. Differentiation between small (< 4.5 cm) true subepithelial tumors and ectopic pancreas in the small bowel on computed tomography enterography. European Radiology, 2022, 32: 1760-1769.
22. Okuhata Y, Maebayashi T, Furuhashi S, et al. Characteristics of ectopic pancreas in dynamic gadolinium-enhanced MRI. Abdom Imaging, 2010, 35(1): 85-87.
23. 中国临床肿瘤学会胃肠间质瘤专家委员会. 中国胃肠间质瘤诊断治疗共识(2017年版). 肿瘤综合治疗电子杂志, 2018, 4(1): 31-43.
24. Xu D, Si GY, He QZ. Correlation analysis of multi-slice computed tomography (MSCT) findings, clinicopathological factors, and prognosis of gastric gastrointestinal stromal tumors. Transl Cancer Res, 2020, 9: 1787-1794.
25. Yang CW, Liu XJ, Wei Y, et al. Use of computed tomography for distinguishing heterotopic pancreas from gastrointestinal stromal tumor and leiomyoma. Abdom Radiol, 2021, 46(1): 168-178.
26. 刘曦娇, 杨采薇, 黄子星, 等. CT 及 MRI 在胃肠道间质瘤靶向治疗疗效评价中的应用. 中国普外基础与临床杂志, 2019, 26(10): 1239-1242.
27. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era—a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
28. Lee MJ, Lim JS, Kwon JE, et al. Gastric true leiomyoma: computed tomographic findings and pathological correlation. J Comput Assist Tomogr, 2007, 31(2): 204-208.
29. Choi YR, Kim SH, Kim S, et al. Differentiation of large (≥5 cm) gastrointestinal stromal tumors from benign subepithelial tumors in the stomach: Radiologists’ performance using CT. Eur J Radiol, 2014, 83(2): 250-260.
30. Yang CW, Che F, Liu XJ, et al. Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis. Insights Imaging, 2021, 12: 144. doi: 10.1186/s13244-021-01089-0.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Imaging manifestations and differential diagnosis of ectopic pancreas

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