Heterotopic pancreatic tissue associated with intra‐ and extrahepatic choledochal cysts

Abstract

A case report of heterotopic pancreas in intra- and extrahepatic biliary tracts in a 36-year-old female who suffered from intra- and extrahepatic choledochal cysts with an anomalous pancreatobiliary duct system. Histologic examination of the resected specimen showed pancreatic tissues located along the wall of the biliary tract with choledochal cysts. The pancreatic tissue consisted of acinar cells and duct elements without Langerhans' islets; the acinar cells were positive immunohistochemically for alpha-amylase and negative for endocrine hormones. Ultrastructural study revealed zymogen granules in the acinar cells. In the present case the heterotopic exocrine pancreatic tissue seems to be etiologically related to choledochal cysts as well as to the anomalous arrangement of the pancreatobiliary duct.

Heterotopic Pancreas in the Common Bile Duct, with a Review of the Literature

“…However, concomitant bile duct stones can induce pancreatitis, and the influence of heterotopic pancreas on the incidence of pancreatitis is unclear. Preoperative biopsies are thought to be ineffective in such cases, as heterotopic pancreatic tissue usually appears in the submucosal layer (3)(4)(5)(6)8). Preoperative biopsies were performed in two of the reported patients, including the current patient, and heterotopic pancreas was not detected in either case.…”

“…Heterotopic pancreas is defined as the presence of pancreatic tissue outside its normal location without any connection to the normal pancreas (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). This condition is very rarely detected during surgery, accounting for 0.2% of cases of laparotomic exploration, compared to 0.55-13.7% of autopsies (11).…”

“…It is primarily observed in the duodenum, stomach, jejunum, Meckel's diverticulum and ileum, being less frequently detected in the omentum, liver, spleen, gallbladder and papilla of Vater (3). The common bile duct (CBD) has also been reported to be a site of origin of heterotopic pancreas, although such cases are very rare (1)(2)(3)(4)(5)(6). We herein report a case of heterotopic pancreas in the CBD that mimicked a biliary papillary tumor and discuss the findings of a review of literature.…”

Heterotopic pancreatic tissue associated with type 1 choledochal cyst, cystolithiasis and gall bladder stones: a rare entity with review of literature

“…It is difficult to explain embryologically the association of heterotopic pancreatic tissue on the wall of choledochal cyst. The possible hypothesis is that there is fetal migration of pancreatic cells into biliary tree, followed by release of pancreatic enzymes from the heterotopic rest present on the wall, which may result in damage and dissolution of the wall leading to dilatation 1. Majority of the patients with heterotopic pancreas are asymptomatic.…”

“…It lacks any vascular continuity with the main pancreatic tissue. In majority of the cases, anomalous fetal development of pancreas is the most common aetiology 1. Its presence is usually found incidentally at the time of autopsy or surgery 1–4.…”