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Resumen El coristoma pancreático, o páncreas heterotópico, es una condición rara en gastroenterología. Esta entidad consiste en el hallazgo de tejido pancreático aberrante, en alguna zona del tracto gastrointestinal, sin continuidad vascular o anatómica con el páncreas normal, es poco reportado y presenta sintomatología variable. Presentamos el caso de un individuo de 46 años con dolor abdominal a quien se le encontró mediante exámenes invasivos un divertículo duodenal, el cual al examen histopatológico e inmunohistoquímico mostró un coristoma pancreático.

Abstract Pancreatic choristoma, also called heterotopic pancreas is a rare condition in gastroenterology. This entity consists of the presence of aberrant pancreatic tissue in some other area of the gastrointestinal tract without vascular or anatomical continuity with the normal pancreas; it has been seldomly reported and it could exhibit variable symptomathology. We herein report the case of a 46-year-old male, who presented with abdominal pain and was found, through invasive examinations to have a pancreatic choristoma within a duodenal diverticulum. The diagnosis was made using histopathology and immune-histochemistry testing.

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Resumen La heterotopia pancreática es un hallazgo poco frecuente, en ocasiones accidental, que se puede observar en cualquier nivel del tracto digestivo e inclusive fuera del mismo; es congénita y su patogenia está en discusión. Aunque su forma de presentación es lenta y progresiva y su comportamiento benigno y asintomático, en ocasiones puede originar manifestaciones obstructivas, hemorrágicas, inflamatorias y neoplásicas. En este último caso es imprescindible el diagnóstico histopatológico. Se presenta el caso de un paciente sintomático con heterotopia pancreática a nivel del píloro gástrico cuya localización es bastante infrecuente.

Abstract Pancreatic heterotopia is rare and is sometimes found accidentally. It can occur anywhere in the digestive tract and even outside of it. Heterotopic pancreas is congenital, but its pathogenesis is under discussion. Although it develops slowly and progressively, its behavior is benign and asymptomatic. Nevertheless, it can manifest in obstructions, hemorrhaging, inflammation and neoplasia. In the latter case, histopathological diagnosis is essential. We present the case of a symptomatic patient with pancreatic heterotopia at the gastric pylorus, a very uncommon location.

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Heterotopic pancreas is usually asymptomatic and does not change throughout the patient's life, but sometimes it can present symp-toms and complications, which are rarely discrete in the literature. We present here a case of heterotopic pancreas in the gastric wall complicated with pseudocyst, and suggest that heterotopic pancreatic pseudocyst should be included in the differential diagnosis of gastric wall cysts.

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We report a 54 years old woman presenting with pain in the right upper abdominal quadrant. An abdominal ultrasound showed multiple gallbladder stones. The patient was operated with the diagnosis of cholelithiasis. During the pathological study of the excised gallbladder a 0.9 cm diameter yellowish nodule was found, that corresponded to heterotopic pancreatic tissue.

La heterotopía pancreática corresponde a la presencia de tejido pancreático fuera de su localización habitual, que carece de continuidad anatómica y vascular con el páncreas normal; el 85 por ciento a 90 por ciento de los casos reportados comprometen estómago, duodeno o yeyuno, mientras que la localización en vesícula biliar es infrecuente y corresponde tan sólo al 1 por ciento de ellas. Esta entidad es generalmente asintomática y en la mayoría de los casos su diagnóstico constituye un hallazgo incidental durante el examen anatomo-patológico de la pieza quirúrgica. Se presenta el caso de una mujer de 54 años sometida a colecistectomía abierta electiva con el diagnóstico de colecistolitiasis. El examen anatomo-patológico de la pieza operatoria, junto con diagnosticar la colecistitis crónica litiásica, describe la presencia de tejido pancreático heterotópico en el espesor de la pared y a nivel del cuello de la vesícula biliar compuesto por acinos y conductos pancreáticos.

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Pancreatic choristoma is the ocurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity.

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La heterotopia pancreática (HP) es una lesión relativamente infrecuente, observada con mayor frecuencia en el estómago. En la mayoría de los casos laHP es asintomática, pero puede ocasionalmente acompañarse de dispepsia y hemorragia gastrointestinal superior. Se describe el caso de un hombre de 40 años de edad con obstrucción del vaciamiento gástrico, secundario a HP en el antro.

Heterotopic pancreas (HP) is a relatively infrequent lesion most often found in the stomach. In the majority of cases, HP does not cause symptoms, but it can occasionally present as dyspepsia and upper gastrointestinal bleeding. This report describes the case of a 40-year-old man with gastric outlet obstruction resulting from HP in gastric antrum.

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