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World Journal of Clinical Cases 2022年第7期10卷 2261-2267页

作者： Tao-Li Wang Xiao-Song Gong Jin Wang Chen-Yan Long Department of Pathology Zhuzhou Hospital Affiliated to Xiangya School of MedicineCentral South UniversityZhuzhou 412007Hunan ProvinceChina The Second Department of General Surgery Zhuzhou Hospital Affiliated to Xiangya School of MedicineCentral South UniversityZhuzhou 412007Hunan ProvinceChina

BACKGROUND Intestinal intussusception caused by intestinal duplication and ectopic pancreas is extremely rare in the clinic and has not been reported previously.CASE SUMMARY A 29-year-old man was admitted to the hospital for chronic abdominal pain and bloating.The preoperative diagnosis was intestinal obstruction and intussusception.Then,laparotomy,partial small intestinal resection and extraintestinal decompression were performed.Postoperative pathology confirmed intestinal duplication and ectopic pancreas.After surgery,the patient recovered well with no complications.No recurrence was observed after more than 5 mo of follow-up.CONCLUSION We report a new case of a young male with intussusception caused by intestinal duplication and ectopic pancreas.Surgery is the main treatment for these conditions.This study aimed to raise awareness and provide information to improve the clinical management of this rare yet serious condition.

关键词： Intestinal intussusception ectopic pancreas Intestinal duplication Intestinal obstruction Adult Case report

Gastric ectopic pancreas combined with synchronous multiple early gastric cancer: A rare case report

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World Journal of Clinical Cases 2023年第7期11卷 1569-1575页

作者： Zhen-Ya Zhao Yue-Xing Lai Ping Xu Department of Gastroenterology Songjiang Hospital Affiliated to Shanghai Jiaotong University School of Medicine(Preparatory Stage)Shanghai 201600China

BACKGROUND A large percentage of patients with ectopic pancreas are asymptomatic.When present,the symptoms are typically non-specific.These lesions are predominantly located in the stomach and benign in nature.Synchronous multiple early gastric cancer(SMEGC)(two or more simultaneous malignant lesions with early gastric cancer)is relatively rare and particularly easy to overlook during endoscopic examination.The prognosis of SMEGC is generally poor.We report a rare case of ectopic pancreas with concomitant SMEGC.CASE SUMMARY A 74-year-old woman presented with paroxysmal upper abdominal pain.On initial investigations,she tested positive for Helicobacter pylori(H.pylori).She underwent esophagogastroduodenoscopy which revealed a 1.5 cm×2 cm major lesion at the greater curvature and a 1 cm minor lesion at the lesser curvature of the stomach.On endoscopic ultrasound,the major lesion showed hypoechoic changes,uneven internal echoes and unclear boundaries between some areas and the muscularis propria.Endoscopic submucosal dissection was performed to excise the minor lesion.A laparoscopic resection was chosen for the major lesion.On histopathological examination,the major lesion contained high grade intraepithelial neoplasia with a small focus of cancer.A separate underlying ectopic pancreas was found under this lesion.The minor lesion contained high grade intraepithelial neoplasia.In this case,the patient was diagnosed with SMEGC with concomitant ectopic pancreas in the stomach.CONCLUSION Patients with atrophy,H.pylori,and other risk factors should be carefully investigated to avoid missing other lesions including SMEGC and ectopic pancreas.

关键词： Synchronous multiple early gastric cancer ectopic pancreas Pathology Case report

Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2799-2808页

作者： Hui-Da Zheng Qiao-Yi Huang Yun-Huang Hu Kai Ye Jian-Hua Xu Department of Gastrointestinal Surgery The Second Affiliated Hospital of Fujian Medical UniversityQuanzhou 362000Fujian ProvinceChina Department of Gynaecology and Obstetrics The Second Affiliated Hospital of Fujian Medical UniversityQuanzhou 362000Fujian ProvinceChina

BACKGROUND Gastric ectopic pancreas(GEP)is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas.It is usually difficult to diagnose through histological examination,and the choice of treatment method is crucial.AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection(LR)and endoscopic submucosal dissection(ESD).METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included.Data on clinical characteristics,endoscopic ultrasonography(EUS),ESD,and LR were collected and analyzed.The characteristics of EUS and the efficacy of the two treatments were analyzed.RESULTS The average age of the patients was 43.31±13.50 years,and the average maximum diameter of the lesions was 1.55±0.70 cm.The lesion originated from the mucosa in one patient(2.04%),from the submucosa in 42 patients(85.71%),and from the muscularis propria in 6 patients(12.25%).Twenty-nine patients(59.20%)with GEP showed umbilical depression on endoscopy.The most common initial symptom of GEP was abdominal pain(40.82%).Tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),were generally within the normal range.One patient(2.04%)with GEP had increased CEA and CA-19-9 levels.However,no cancer tissue was found on postoperative pathological examination,and tumor markers returned to normal levels after resecting the lesion.There was no significant difference in surgery duration(72.42±23.84 vs 74.17±12.81 min)or hospital stay(3.70±0.91 vs 3.83±0.75 d)between the two methods.LR was more often used for patients with larger tumors and deeper origins.The amount of bleeding was significantly higher in LR than in ESD(11.28±16.87 vs 16.67±8.76 mL,P<0.05).Surgery was associated with complete resection of the lesion without any serious complications;there were no case

关键词： ectopic pancreas Endoscopic ultrasonography Endoscopic submucosal dissection Laparoscopic resection

Gastric and intestinal ectopic pancreas: Two case reports

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World Journal of Clinical Cases 2023年第29期11卷 7221-7226页

作者： Huan Zhang Hong-Yu Zhao Feng-Hua Zhang Wei Liang Department of General Surgery Hebei General HospitalShijiazhuang 050051Hebei ProvinceChina

BACKGROUND ectopic pancreas may be unfamiliar to many people because it is rare and difficult to diagnose.However,this disease is highly susceptible to misdiagnosis and missed diagnosis.In this article,we report two cases of pancreatic heterotopia in the gastric sinus and small intestine,respectively,both of which were confirmed by histopathological examination.CASE SUMMARY The first patient was a 43-year-old female which reported abdominal distension for 2 mo.The second was a 67-year-old female who experienced intermittent epigastric discomfort for 15 d.In both cases,there was no confirmed preoperative examination,and the postoperative pathology indicated the presence of ectopic pancreas.CONCLUSION The diagnosis of ectopic pancreas is difficult,and is often prone to misdiagnosis and the possibility of being overlooked.Various laboratory tests and imaging tests should be carefully evaluated before surgery to achieve early detection,early diagnosis and early treatment.

关键词： Gastric Intestinal ectopic pancreas Case report

Pancreatic intraepithelial neoplasia arising from an ectopic pancreas in the small bowel

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Hepatobiliary & Pancreatic Diseases International 2014年第6期13卷 658-661页

作者： Francisco Igor Macedo Deepa Taggarshe Tafadzwa Makarawo Barry Herschman Michael J Jacobs Department of General Surgery Providence Hospital and Medical Centers Southfield MI 48075 USA Department of General Surgery Providence Hospital and Medical Centers Southfield MI 48075 USA Department of Pathology Providence Hospital and Medical Centers Southfield MI 48075 USA

BACKGROUND： ectopic pancreatic tissue is relatively uncommon, and is characterized as pancreatic tissue with no contact with the normal pancreas, and with its own ductal system and blood supply. It is usually asymptomatic, and can be incidentally diagnosed by conventional imaging studies. METHOD： A 69-year-old woman with a prior history of bilateral breast carcinoma presented with ectopic pancreatic intraepithelial neoplasia （PanIN） that was identified incidentally in the small bowel during an oncological resection of a synchronous primary pancreatic adenocarcinoma, and renal cell carcinoma. RESULTS： The patient underwent subtotal pancreatectomy with splenectomy, regional lymphadenectomy, radical left nephrectomy, and small bowel resection with primary anastomosis of ectopic PanlN-2. She had an uneventful hospitalization and was discharged home on postoperative day 7. CONCLUSIONS： The occurrence of ectopic PanIN is extremely unusual with only few cases previously reported in the literature. The need for negative margins after surgical resection of ectopic PanIN lesions remains controversial.

关键词： ectopic pancreas pancreatic intraepithelial neoplasia PanIN pancreatic adenocarcinoma

ectopic pancreas at the ampulla of Vater diagnosed with endoscopic snare papillectomy: A case report and review of literature

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World Journal of Gastrointestinal Endoscopy 2021年第9期13卷 437-446页

作者： Manoj A Vyawahare Naga Bharati Musthyla Department of Medical Gastroenterology American Oncology Institute at Nangia Specialty HospitalNagpur 440028MaharashtraIndia Department of Pathology AmPath Central Reference LaboratoryHyderabad 500019TelanganaIndia

BACKGROUND ectopic pancreas is a rare developmental anomaly that results in a variety of clinical presentations.Patients with ectopic pancreas are mostly asymptomatic,and if symptomatic,symptoms are usually nonspecific and determined by the location of the lesion and the various complications arising from it.ectopic pancreas at the ampulla of Vater(EPAV)is rare and typically diagnosed after highly morbid surgical procedures such as pancreaticoduodenectomy or ampullectomy.To our knowledge,we report the first case of confirmed EPAV with a minimally invasive intervention.CASE SUMMARY A 71-year-old male with coronary artery disease,presented to us with new-onset dyspepsia with imaging studies revealing a‘double duct sign’secondary to a small subepithelial ampullary lesion.His hematological and biochemical investigations were normal.His age,comorbidity,poor diagnostic accuracy of endoscopy,biopsies and imaging techniques for subepithelial ampullary lesions,and suspicion of malignancy made us acquire histological diagnosis before morbid surgical intervention.We performed balloon-catheter-assisted endoscopic snare papillectomy which aided us to achieve en bloc resection of the ampulla for histopathological diagnosis and staging.The patient’s post-procedure recovery was uneventful.The en bloc resected specimen revealed ectopic pancreatic tissue in the ampullary region.Thus,the benign histopathology avoided morbid surgical intervention in our patient.At 15 mo follow-up,the patient is asymptomatic.CONCLUSION EPAV is rare and remains challenging to diagnose.This rare entity should be included in the differential diagnosis of subepithelial ampullary lesions.Endoscopic en bloc resection of the papilla may play a vital role as a diagnostic and therapeutic option for preoperative histological diagnosis and staging to avoid morbid surgical procedures.

关键词： ectopic pancreas Heterotopic pancreas Ampulla of Vater Endoscopic snare papillectomy Ampullary tumors Case report

Laparoscopic Resection of ectopic pancreas in the Gastric Antrum: Case Report and Literature Review

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Laparoscopic Resection of Ectopic Pancreas in the Gastric An...

Clinical classification of symptomatic heterotopic pancreas of the stomach and duodenum:A case series and systematic literature review

第十七届中国内镜医师大会

作者： HU Hai ZHAO Zhong-Xin ZHU Jian-Fan SUO Guang-Jun (Center of Minimal Invasive Surgery,Shanghai Eastern Hospital,Tongji University,Shanghai 200000,P.R.China)

＜正＞We report two cases of ectopic pancreas in the gastric antrum that were removed using minimally invasive approaches.A 65-year-old woman with bloating,dysphasia and heartburn,and a 49-year-old woman with developed sporadic epigastric pain and vomiting were referred for upper gastroendoscopic examination.A submucosal lesion in the antrum was revealed in both of them.A le- sion 2 cm in diameter was located in the anterior wall at 5 cm from the pylorus in the first patient,a 1.5 cm lesion in the posterior wall with a distance of 3 cm from the pylorus in the other patient.A la- paroseopic wedge resection of the gastric antrum was performed for the first patient.A distal Bill- roth-Ⅰ gastrectomy was Tarried out for the second patient.Both of them had uneventful recoveries on 3-6 months follow-up.Our experiences suggest that laparoscopic wedge resection and distal Bill- roth-Ⅰ gastrectomy are safe and effective approaches for treatment of ectopic pancreas in gastric antrum.

关键词： ectopic pancreas laparoscopic resection gastric antrum

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World Journal of Gastroenterology 2022年第14期28卷 1455-1478页

作者： Michael T Le Compte Brandon Mason Keenan J Robbins Motoyo Yano Deyali Chatterjee Ryan C Fields Steven M Strasberg William G Hawkins Department of Surgical Oncology University of North CarolinaRaleighNC 27608United States Department of Radiology Stillwater Medical CenterStillwaterOK 74074United States Department of General Surgery Washington University St.LouisSt.LouisMO 63110-8109United States Department of Radiology Mayo ClinicPhoenixAZ 8505United States Department of Pathology and Immunology MD Anderson Cancer CenterHoustonTX 77030United States Department of Surgical Oncology Washington University School of MedicineSt.LouisMO 63110-8109United States Section of Hepatobiliary-Pancreatic and GI Surgery Washington University St.LouisSt.LouisMO 63110United States

BACKGROUND Heterotopic pancreas(HP)is an aberrant anatomic malformation that occurs most commonly in the upper gastrointestinal tract.While the majority of heterotopic pancreatic lesions are asymptomatic,many manifest severe clinical symptoms which require surgical or endoscopic intervention.Understanding of the clinical manifestations and symptoms of HP is limited due to the lack of large volume studies in the literature.The purpose of this study is to review symptomatic cases at a single center and compare these to a systematic review of the literature in order to characterize common clinical manifestations and treatment of this disease.AIM To classify the common clinical manifestations of heterotopic pancreas.METHODS A retrospective review was conducted of pathologic samples containing heterotopic pancreas from 2000-2018.Review was limited to HP of the upper gastrointestinal tract due to the frequency of presentation in this location.Symptomatic patients were identified from review of the medical records and clinical symptoms were tabulated.These were compared to a systematic review of the literature utilizing Pub Med and Embase searches for papers pertaining to heterotopic pancreas.Publications describing symptomatic presentation of HP were selected for review.Information including demographics,symptoms,presentation and treatment were compiled and analyzed.RESULTS Twenty-nine patient were identified with HP at a single center,with six of these identified has having clinical symptoms.Clinical manifestations included,gastrointestinal bleeding,gastric ulceration with/without perforation,pancreatitis,and gastric outlet obstruction.Systemic review of the literature yielded 232 publications detailing symptomatic cases with only 20 studies describing ten or more patients.Single and multi-patient studies were combined to form a cohort of 934 symptomatic patients.The majority of patients presented with abdominal pain(67%)combined with one of the following clinical categories:(1)Dyspepsia,(n=445,48%);(2)Pancreatitis(n=

关键词： Heterotopic pancreas ectopic pancreas Aberrant pancreas Pancreatic rest Groove pancreatitis

Colonic ductal adenocarcinoma case report: New entity or rare ectopic degeneration?

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World Journal of Gastrointestinal Endoscopy 2023年第3期15卷 191-194页

作者： Clara Benedetta Conti Giacomo Mulinacci Nicolò Tamini Marta Jaconi Nicola Zucchini Interventional Endoscopy ASST MonzaOspedale San GerardoMonza 20900Italy Department of Surgery ASST MonzaOspedale San GerardoMonza 20900Italy Department of Pathology ASST MonzaOspedale San GerardoMonza 20900Italy

BACKGROUND ectopic pancreatic tissue is a congenital anomaly where a part of pancreatic tissue is located outside of the pancreas and lacks vascular or anatomical communication with it but shows the same histological features.Currently,the literature reports only two anecdotal cases of malignant transformation of colonic ectopic pancreas.CASE SUMMARY We present a case of an 81-year-old patient presenting with anemia,with right colonic neoplasia and carbohydrate antigen 19-9 above the normal values.She underwent laparoscopic right hemicolectomy.The final histology was consistent with a primitive adenocarcinoma with ductal morphology and solid-predominant growth pattern.Benign ectopic pancreatic tissue was absent in the surgical specimen.CONCLUSION The case describes a very rare complete degeneration of a colonic ectopic pancreatic tissue.However,the absence of benign ectopic pancreatic tissue in the surgical specimen is suggestive of the first description of a primitive ductal adenocarcinoma of the colon.

关键词： Pancreatic cancer Colorectal cancer Colonic ductal adenocarcinoma ectopic pancreas Case report

Malignant transformation of ectopic pancreatic cells in the duodenal wall

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World Journal of Gastroenterology 2010年第10期16卷 1293-1295页

作者： Roberto Bini Paolo Voghera Alberto Tapparo Raffaele Nunziata Andrea Demarchi Matteo Capocefalo Renzo Leli Department of General and Emergency Surgery San Giovanni Bosco Hospital Department of Pathology San Giovanni Bosco Hospital Department of Microbiology and Bio-chemistry The University of Leeds

ectopic pancreas (EP) is the relatively uncommon presence of pancreatic tissue outside the normal location of the pancreas. This condition is usually asymptomatic and rarely complicated by pancreatitis and malignant transformation. A few cases of neoplastic phenomena that developed from EP into the duodenal wall are described in the literature. Herein we report a case of gastric outlet obstruction due to adenocarcinoma arising from EP of the duodenal wall. The patient underwent a Whipple's procedure and had an uneventful post-operative recovery. Traditional imaging studies are often inconclusive in the definitive diagnosis, whilst endoscopic ultrasonography and guided biopsy may aid accurate pre-operative diagnosis. Diagnostic uncertainty warrants surgical exploration and if necessary extended resection is indicated.

关键词： ectopic pancreas Duodenum Gastrointestinal obstruction Neoplasm Pancreaticoduodenectomy