Heterotopic pancreas: Histopathologic features, imaging findings, and complications

Maryam Rezvani, Christine Menias, Kumar Sandrasegaran, Jeffrey D. Olpin, Khaled M. Elsayes, Akram M. Shaaban

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Heterotopic pancreas is a congenital anomaly in which pancreatic tissue is anatomically separate from the main gland. The most common locations of this displacement include the upper gastrointestinal tract—specifically, the stomach, duodenum, and proximal jejunum. Less common sites are the esophagus, ileum, Meckel diverticulum, biliary tree, mesentery, and spleen. Uncomplicated heterotopic pancreas is typically asymptomatic, with the lesion being discovered incidentally during an unrelated surgery, during an imaging examination, or at autopsy. The most common computed tomographic appearance of heterotopic pancreas is that of a small oval intramural mass with microlobulated margins and an endoluminal growth pattern. The attenuation and enhancement characteristics of these lesions parallel their histologic composition. Acinus-dominant lesions demonstrate avid homogeneous enhancement after intravenous contrast material administration, whereas duct-dominant lesions are hypovascular and heterogeneous. At magnetic resonance imaging, the heterotopic pancreas is isointense to the orthotopic pancreas, with characteristic T1 hyperintensity and early avid enhancement after intravenous gadolinium-based contrast material administration. Heterotopic pancreatic tissue has a rudimentary ductal system in which an orifice is sometimes visible at imaging as a central umbilication of the lesion. Complications of heterotopic pancreas include pancreatitis, pseudocyst formation, malignant degeneration, gastrointestinal bleeding, bowel obstruction, and intussusception. Certain complications may be erroneously diagnosed as malignancy. Paraduodenal pancreatitis is thought to be due to cystic degeneration of heterotopic pancreatic tissue in the medial wall of the duodenum. Recognizing the characteristic imaging features of heterotopic pancreas aids in differentiating it from cancer and thus in avoiding unnecessary surgery.

Original languageEnglish (US)
Pages (from-to)484-499
Number of pages16
JournalRadiographics
Volume37
Issue number2
DOIs
StatePublished - Mar 1 2017

Fingerprint

Pancreas
Choristoma
Duodenum
Pancreatitis
Contrast Media
Unnecessary Procedures
Meckel Diverticulum
Mesentery
Intussusception
Gadolinium
Biliary Tract
Jejunum
Ileum
Esophagus
Autopsy
Neoplasms
Stomach
Spleen
Magnetic Resonance Imaging
Hemorrhage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Heterotopic pancreas : Histopathologic features, imaging findings, and complications. / Rezvani, Maryam; Menias, Christine; Sandrasegaran, Kumar; Olpin, Jeffrey D.; Elsayes, Khaled M.; Shaaban, Akram M.

In: Radiographics, Vol. 37, No. 2, 01.03.2017, p. 484-499.

Research output: Contribution to journalArticle

Rezvani, M, Menias, C, Sandrasegaran, K, Olpin, JD, Elsayes, KM & Shaaban, AM 2017, 'Heterotopic pancreas: Histopathologic features, imaging findings, and complications', Radiographics, vol. 37, no. 2, pp. 484-499. https://doi.org/10.1148/rg.2017160091
Rezvani, Maryam ; Menias, Christine ; Sandrasegaran, Kumar ; Olpin, Jeffrey D. ; Elsayes, Khaled M. ; Shaaban, Akram M. / Heterotopic pancreas : Histopathologic features, imaging findings, and complications. In: Radiographics. 2017 ; Vol. 37, No. 2. pp. 484-499.
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