Imaging findings for pancreatic Hamartoma: two case reports and a review of the literature

Cui, Heng; Lian, Yuqing; Chen, Feng

doi:10.1186/s12876-020-1185-8

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…The cases reported often do not include detailed intraoperative descriptions, but those that do often reported intimate involvement with the head or uncinate process of the pancreas and surrounding structures, often necessitating a pancreaticoduodenectomy (2,3,6,8,12). This is consistent with our patient's ndings, although the tumor was able to be resected with a portion of the uncinate process and duodenum without formal pancreaticoduodenectomy (Figure 4).…”

Section: Discussionsupporting

confidence: 83%

“…They are most often located in the head or uncinate process of the pancreas. MRI can depict the solid component as an iso-low intensity of T1 weighted image and an iso-high on T2 weighted image (3,4). FDG-PET (Fluorodeoxyglucose Positron Emission Tomography) demonstrated uptake in approximately 20% of patients reviewed, which may lead to the misdiagnosis of the lesions as pancreatic adenocarcinoma (4).…”

Section: Discussionmentioning

confidence: 99%

“…Recommendation for resection is often di cult since many patients are asymptomatic with small, incidentally found lesions, with unknown biologic behavior in the setting of potentially high morbidity operations. There is no evidence in current literature that PLH can undergo malignant transformation, and there have been no reports of rupture or bleeding resulting from these tumors (1,3,4,6).…”

Section: Discussionmentioning

confidence: 99%

“…The term hamartoma refers to the focal outgrowth of cells and tissues native to the organ in which it occurs, and is considered a malformation rather than a true neoplasm (1). Pancreatic hamartomas account for less than 1% of all hamartomas and 10% of primary mesenchymal tumors of the pancreas (1)(2)(3). Pancreatic masses consisting of lipomatous contents include lipoma, liposarcoma, lipomatous pseudohypertrophy, and other fat-containing neoplasms such as perivascular epithelioid cell tumor and malignant neoplasm with lipoid degeneration.…”

Section: Introductionmentioning

confidence: 99%

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A Massive Retroperitoneal Tumor – An Unusual Presentation of a Rare Primary Pancreatic Neoplasm

Clegg

Hammond

Schmocker

et al. 2022

Preprint

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Background:The differential diagnosis for retroperitoneal masses is broad, and includes pancreatic lipomatous hamartoma, a rare but benign disease process. Hamartoma describes outgrowth of tissue native to the organ in which it occurs and is considered a malformation rather than a true neoplasm. Pancreatic hamartomas consist of less than 1% of all hamartomas, and few cases of pancreatic lipomatous tumors with distinct components of pancreatic hamartoma have been described. These tumors are difficult to diagnose on imaging and biopsy alone and can appear malignant with potential for significant mass effect on surrounding organs, leading to surgical intervention for definitive diagnosis. Case Presentation:A 57-year-old male presented with right upper quadrant pain radiating to his left side and back. Ultrasound demonstrated cholelithiasis and an incidentally discovered large retroperitoneal mass. Computed tomography (CT) imaging demonstrated a 14.4 x 4.6 x 16 cm heterogenous, fatty-appearing retroperitoneal mass displacing the colon and small bowel, while abutting the aorta and inferior vena cava (IVC) with no obvious invasion of surrounding structures. He underwent laparoscopic cholecystectomy with biopsy of the mass. Biopsy demonstrated benign adipose tissue and no evidence of malignancy, and his care was transferred to our facility. His postoperative course was complicated by acute congestive heart failure that ultimately delayed definitive surgical intervention for nine months. Progressive growth of the mass was noted on serial imaging as his cardiopulmonary status was optimized. Preoperative CT revealed a 20.2 x 28.2 x 14.1 cm with worsened mass effect on surrounding structures.The patient underwent open resection of the retroperitoneal mass with en bloc resection of the third and fourth portions of the duodenum and the uncinate process of the pancreas. The final pathologic diagnosis was benign lipomatous proliferation with features most consistent with pancreatic lipomatous hamartoma (PLH), with specimen weight of 3810g and overall dimensions of 35 x 27 x 14 cm.Conclusions:PLH is an extremely rare benign tumor, which is notoriously difficult to diagnose with imaging and biopsy alone. This case highlights the difficulty delineating benign from malignant tumors of the pancreas and retroperitoneum.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Massive Retroperitoneal Tumor – An Unusual Presentation of a Rare Primary Pancreatic Neoplasm

Clegg

Hammond

Schmocker

et al. 2022

Preprint

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“…Our case shows that pancreatic hamartoma can be preoperatively diagnosed using EUS–FNAB. Pancreatic hamartoma is a very rare, non‐neoplastic, mass‐forming pancreatic lesion, 1 with only 64 cases reported in the English literature and 7 in the Japanese literature, without abstract only (based on literature searches using the PubMed and Japanese Ichushi databases) 1–51 . As pancreatic hamartoma is typically asymptomatic, in more than half the abovementioned reports, the cases has been incidentally discovered 1–51 .…”

Section: Discussionmentioning

confidence: 99%

Pancreatic hamartoma: Possibility of a preoperative diagnosis via endoscopic ultrasound–guided fine‐needle aspiration biopsy

Shintaku

Gokita

Oshima

et al. 2023

Diagnostic Cytopathology

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Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) is useful for preoperatively diagnosing various pancreatic tumors. Although there is a risk of complications, such as pancreatitis, this procedure achieves the crucial need of reducing unnecessary invasive surgery for benign lesions. Herein, we reported a surgically resected case of pancreatic hamartoma in the pancreatic head whose retrospective analysis revealed that the specimens obtained via EUS-FNAB contained hamartoma fragments. Pancreatic hamartoma is an extremely rare benign disease that is exceptionally difficult to diagnose before surgical resection owing to its rarity and lack of established imaging findings. To the best of our knowledge, the preoperative diagnosis of pancreatic hamartoma via EUS-FNAB specimens has not been reported to date. Herein, postoperative EUS-FNAB evaluation revealed a collection of pancreatic hamartoma lesions, although the initial diagnosis was pancreatic tissue with focal atrophy and fibrosis. Diagnosis using EUS-FNAB can be challenging owing to the very small sample size. If mature acini and ducts with fibrous stroma without islets are observed in the EUS-FNAB specimen, pancreatic hamartoma should be considered as a differential diagnosis. Thus, careful follow-up or reexamination of EUS-FNAB should be considered instead of surgery if a benign lesion is suspected preoperatively.

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A case of solid-type pancreatic hamartoma presenting high apparent diffusion coefficient value: histopathological correlation and literature review

et al. 2022

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Imaging findings for pancreatic Hamartoma: two case reports and a review of the literature

Cited by 12 publications

References 22 publications

A Massive Retroperitoneal Tumor – An Unusual Presentation of a Rare Primary Pancreatic Neoplasm

A Massive Retroperitoneal Tumor – An Unusual Presentation of a Rare Primary Pancreatic Neoplasm

Pancreatic hamartoma: Possibility of a preoperative diagnosis via endoscopic ultrasound–guided fine‐needle aspiration biopsy

A case of solid-type pancreatic hamartoma presenting high apparent diffusion coefficient value: histopathological correlation and literature review

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