Gastric heterotopic pancreas and stromal tumors smaller than 3 cm in diameter: clinical and computed tomography findings

Abstract

BackgroundIdentifying gastric heterotopic pancreas and stromal tumors is difficult. Few studies have reported computed tomography (CT) findings for differentiating lesions less than 3 cm in diameter. In this study, we aimed to identify clinical characteristics and CT findings that can differentiate gastric heterotopic pancreatic lesions from stromal tumors less than 3 cm in diameter.MethodsA total of 132 patients with pathologically confirmed gastric heterotopic pancreas (n = 66) and stromal tumors (n = 66) were included. Each group was divided into primary (n = 50) and validation cohort (n = 16). Clinical characteristics and CT findings were retrospectively reviewed. CT findings included location, border, contour, growth pattern, enhancement pattern and grade, the enhancement value of tumor, enhancement ratio of tumor, and enhancement ratio of tumor to pancreas in venous phase. The findings in the two groups were compared using the Pearson χ2 test or Student t-test. Receiver operating characteristic curves were used to determine areas under the curve and optimal cut-offs.ResultsSignificant differences were observed between heterotopic pancreas and stromal tumors in the distribution of tumor location, border, contour (all P < 0.001), enhancement values (P < 0.001), enhancement ratios of tumors (P < 0.001), and enhancement ratios of tumors to pancreas (P < 0.001). No significant differences existed in growth pattern (P = 0.203). The area under the curve differed significantly between enhancement ratio of tumor to pancreas and enhancement ratio (P = 0.030). There were significant differences in above characteristics between two groups in validation cohort.ConclusionsHeterotopic pancreas has characteristic CT features differentiating it from stromal tumors.

Insight into gastrointestinal heterotopic pancreas: imaging evaluation and differential diagnosis

“…c, d Axial enhanced CT images of a heterotopic pancreas in the gastric antrum of a 58-year-old male showed a 1.2 cm × 0.8 cm, oval, ill-defined, and endoluminal lesion (white arrows), with a long diameter to short diameter > 1.4 lesion to aorta ratio method, but also combined significant variables in univariate analysis and achieved higher area under the curve values. Liu et al [41] and Li et al [32] both focused on the differentiation of gastric HP from gastric stromal tumors (GST); they have some differences and emphases. Liu et al [41] collected all GST in their study with a diameter limitation of ≥ 1 cm and calculated the CT attenuation disparities by using the enhanced CT attenuation value minus that of unenhanced phase while Li et al [32] limited the lesion diameter of < 3 cm, utilized stratified random sampling method to rate same sample sizes of gastric HP and GST, and employed the group validation method to prove the drawn conclusion of the primary cohort.…”

“…GHP often presents as an intramural oval mass with indistinct margins on CT coronal images [ 23 , 30 ]. GHP is usually small in diameter (often less than 3 cm) and tends to be an intraluminal growth pattern [ 6 , 14 , 31 , 32 ]. The CT attenuation, enhancement heterogeneity, and enhancement degree of GHP correlate with its pathological histological compositions [ 5 , 9 , 10 , 14 , 23 , 33 ].…”

Gastrointestinal Tract Heterotopic Pancreas: Asymptomatic Pathology?

“…In their large series studies, Zhang et al [ 15 ] and Betzler et al [ 16 ] reported that almost 85% of heterotopic pancreas cases were diagnosed incidentally. On the other hand, heterotopic pancreas was symptomatic in 35% and 100% of patients in other studies [ 17 - 19 ], respectively. The most common presenting symptom in the previously mentioned studies was abdominal pain (23-50%).…”

Endoscopic submucosal dissection for gastric ectopic pancreas: a single-center experience

“…Currently, there are some limitations in diagnosing gastric EP. The imaging examination such as computed tomography and barium meal seems not very helpful in the diagnosis of gastric EP [19]. Pathological diagnosis is the gold standard.…”