title: Heterotopic pancreas: a clinicopathological study of 184 cases from a single high-volume medical center in China.
abstract: Heterotopic pancreas (HP) is often an incidental finding during operative or endoscopic procedures and described in case reports and small series in the literature. Large clinicopathological studies with a systematic analysis remain lacking. Herein, we identified 184 (0.18%; 184/99 544) consecutive histology-proven HP cases of 89 770 surgical resections and 9774 upper endoscopic biopsies carried out at a single medical center in China. Each case was diagnosed by unequivocal identification of pancreatic acini at a location outside the pancreas. The patients' median age was 49 years (range, 14-82) with a slight female predominance (male/female ratio, 0.94). Clinical presentation at diagnosis was nonspecific. Preoperatively, most (54.9%; 101/184) HP lesions were misdiagnosed. Only 26 HP lesions (14.1%) were correctly diagnosed, all in the stomach except for 1 in the duodenum; 57 (31%) were detected during operative procedures for other conditions. The most frequent location of HP was, in descending order, the stomach (97; 52.7%), small intestine (48; 26%), lesser and greater curvature omentum (18; 10%), spleen and hilar region (5; 2.7%), porta hepatis (2; 1%), gallbladder (1; 0.5%), peridistal esophageal tissue (4; 2.2%), and mesentery (7; 3.8%). The size of HP varied from smaller than 0.5 cm (35.3%), 0.6 to 1 cm (34.8%), to larger than 1.1 cm (29.9%). Because of difficulty in preoperative diagnosis, careful workup for upper gastrointestinal diseases with HP as a differential diagnosis may increase the chance of accurate diagnosis and appropriate patient management.
authors.affiliation: Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
authors.forename: Yifen
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
authors.forename: Xitai
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Gold
authors.affiliation: Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Department of Gastroenterology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Lv
authors.affiliation: Department of Laparoscopic Surgery, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Pathology, Nanjing Drum Tower Hospital, Nanjing, Jiangsu Province 210008, China; Department of Pathology and Laboratory Medicine, Veterans Affairs Boston Healthcare System and Harvard Medical School, West Roxbury, MA 02132. Electronic address: qinhuang0122@gmail.com.
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002681:China / Q000453:epidemiology; D002828:Choristoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004066:Digestive System Diseases / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D013505:Digestive System Surgical Procedures; D016099:Endoscopy, Gastrointestinal; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010179:Pancreas; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017678:Sex Distribution; D055815:Young Adult
keywords: Endoscopic ultrasound; Endoscopy; Gastrointestinal tract; Heterotopic pancreas; Stomach