Heterotopic cystic pancreas as a growing submucous tumor close to the cardia of the stomach

Ectopic pancreas, presenting as a growing submucosal tumor, is a rarity in stomach surgery. Up to now, only about 250 cases of ectopic pancreas have been described. To our knowledge this is the first report of ectopic pancreas found near the cardia. A 52 year old female patient suffered from unclear upper abdominal distress. Gastroscopy revealed a submucosal growing tumor near the cardia. The tumor was locally exceeded and histologically examined showing ectopic, cystic pancreatic tissue without signs of malignancy. Wound healing was without complications and the patient is now, two years later, free of symptoms. The preoperative diagnosis of ectopic pancreas still is rarely conclusive. Nevertheless, new techniques such as endoscopic sonography or transmucosal biopsies may provide a non-invasive alternative to surgery. However, currently, local excision with intraoperative frozen section still is the therapy of choice.     

CT与胃肠道造影诊断小肠原发恶性肿瘤的比较研究

目的评价CT和常规胃肠道造影对小肠原发恶性肿瘤诊断的准确性。方法收集52例经手术和病理证实小肠原发恶性肿瘤的胃肠道造影、CT、血管造影及临床资料,回顾性分析其胃肠道造影和CT影像特征,并与手术和病理学结果进行对照。结果 52例小肠原发恶性肿瘤中腺癌19例,恶性间质瘤10例,恶性淋巴瘤23例。常规胃肠道造影主要表现为肠管狭窄、充盈缺损、管壁僵硬、黏膜破坏及环状皱襞消失、肠梗阻、肠套叠及溃疡形成等,41例得到了准确定位,肯定肿瘤诊断32例。CT检查20例,主要表现为局部肠壁增厚、小肠肿块、肠管狭窄、肠梗阻、肠套叠等,均得到了准确定位,肯定肿瘤诊断18例。肠系膜上动脉造影3例,均明确了出血的部位,但术前均误诊为血管畸形。结论 CT对小肠原发恶性肿瘤的诊断具有更高的准确性,并能提供有关肿瘤局部浸润、淋巴结远处转移以及并发症等影像学信息,常规胃肠道造影与CT检查相结合有助于制订出更为恰当的治疗计划。     

胃异位胰腺的内镜超声图像特征分析

目的 探讨内镜超声(EUS)对胃异位胰腺的诊断价值.方法 回顾性分析23例病理诊断胃异位胰腺的EUS特征,主要指标包括病变起源层次、内部回声特征、边缘、边界、长短轴比例、病变处固有肌层厚度等.结果 23例患者中超声内镜诊断符合率91%(21/23).EUS下异位胰腺可起源于胃壁的第二、第三或第四层(5层结构),其中起源于第三层者最多见(15/23,65%).病变多呈中等不均匀回声,内部有管道样结构或无回声区者占43%(10/23),边界不清者占70%(16/23).异位胰腺平均长短轴比例 1.7;病变起源于第二和(或)第三层的病变,局部固有肌层较周围增厚者占71%(12/17).结论 EUS对胃异位胰腺的诊断正确性较高.典型的胃异位胰腺EUS特征包括:壁内侧向生长,黏膜下层起源,边界不规则、不清,中等不均匀回声,内部有无回声区,固有肌层增厚.

Abstract：

Objective To describe the characteristic endoscopic ultrasonography (EUS) features of gastric ectopic pancreas.Methods Totally 23 patients were diagnosed pathologically as having gastric ectopic pancreas.The EUS images of the lesions were retrospectively reviewed regarding layer of origin,size,growth pattern,margin,and internal echo pattern.Results The coincidence of EUS and pathologic diagnosis was 91%(21/23).EUS revealed that the lesions originated from the second,third,and/or fourth layers of the gastric wall.Most lesions were heterogenous,mainly isoechoic.The borders of the lesions were indistinct in 70%(16/23) patients. Anechoic cystic or tubular structures within the lesions appeared in 10 of the 23 lesions(43%).The mean longest/shortest diameter ratio of ectopic pancreas was 1.7.Conclusions Characteristic EUS features of gastric ectopic pancreases include:mural lateral growth pattern,third layer (submucosa) origin,indistinct margin,intermediate echogenecity,anechoic areas,and fourth-layer thickening.Careful assessment of the EUS findings may be a useful aid in the diagnosis of gastric ectopic pancreas.     

酒精性胰腺损害患者的超声表现及分析

目的探讨酒精性胰腺损害患者的超声表现,为临床提供诊断依据。方法对480例酗酒者进行胰腺超声检查,发现胰腺结构改变患者的163例,按酗酒时间长短将其分为短期酗酒组35例和长期酗酒组128例,对比分析两组胰腺结构,并根据酗酒时间、年龄、饮酒量对胰腺声像图的影响进行分析。结果长期酗酒组胰头、胰体及胰尾前后径均小于短期酗酒组(t=13.572,P=0.000;t=-10.010,P=0.001;t=-10.700,P=0.001);胰腺萎缩、回声增强与酗酒者年龄和酗酒时间高度相关(t=2.563,P=0.012;t=3.302,P=0.001)。结论超声检查对酒精性胰腺损害患者具有重要的诊断价值,可为临床诊治提供可靠依据。     

内镜黏膜剥离术治疗上消化道异位胰腺36例临床观察

目的探讨内镜黏膜剥离术(ESD)在上消化道异位胰腺病理诊断和临床治疗的价值。方法检索2012年1月1日-2014年11月30日在南京大学鼓楼临床医学院住院病例,筛选因异位胰腺住院行ESD的病例,归纳总结出资料完整的病例共36例,全部病例均经术后病理证实为异位胰腺,回顾分析操作过程、标本病理、随访治疗效果及并发症情况。结果 ESD治疗胃异位胰腺34例,十二指肠异位胰腺2例,平均操作时间66 min,平均切下标本大小21.0 mm×16.0 mm,标本完整切除率100.00%。随访并发症中,发热2例、上消化道出血1例、穿孔1例。结论 ESD是目前较先进的微创治疗手段,可完整切除病变组织,获取准确病理学诊断,是异位胰腺安全有效的治疗方法。     

41例异位妊娠声像图分析及超声诊断价值探讨

目的 探讨异位妊娠的超声表现及超声诊断价值。方法 对我院近四年来经B超检查、保守治疗或手术及病理检查证实的41例异位妊娠声像图表现作回顾性分析。结果 胎囊型7例（占17．07％）;宫旁非特异性包块21例（占51．22％）;盆腔、腹腔积液36例（占87．8％）;手术病例的超声诊断符合率88．2％（30／34）。结论 B超诊断异位妊娠准确性较高,可作为首选的辅助诊断方法;充分掌握异位妊娠的各种超声表现、鉴别诊断要点和临床诊断依据,可以提高B超诊断率。     

输卵管完全性葡萄胎误诊临床病理分析并文献复习

目的探讨输卵管完全性葡萄胎临床及病理特征、诊治方法、误诊原因、误诊防范措施。方法对2例曾误诊的输卵管完全性葡萄胎的临床资料进行回顾性分析并复习相关文献。结果本文1例因停经2月余,阴道出血6 d入院。查血β人绒毛膜促性腺激素(β-HCG)17 229.3 U/L。术前误诊为异位妊娠,行输卵管切除术。1例因阴道不规律出血1月余,下腹闷痛2周,加剧5 d入院。无明确停经史。查血β-HCG 84 140.0 U/L。术前考虑盆腔炎性包块,卵巢囊肿蒂扭转,异位妊娠。行开腹右输卵管切除、左输卵管结扎及诊断性刮宫术。2例均经术后病理检查确诊为输卵管完全性葡萄胎,皆随访2年,无异常发现。结论输卵管葡萄胎较少见,临床易误诊。临床医生应提高对本病的认识,在遇到类似异位妊娠表现患者时应想到异位葡萄胎的可能性,要综合全面对患者病情进行分析,并仔细鉴别诊断,以减少误诊误治。     

妊娠滋养细胞疾病误诊为异位妊娠三例临床分析及文献复习

目的探讨误诊为异位妊娠的妊娠滋养细胞疾病(gestational trophoblastic disease,GTD)患者的临床特点、诊治方法、误诊原因及防范措施。方法回顾性分析曾诊断异位妊娠、经术后病理检查确诊的GTD 3例临床资料。结果本组2例因急腹症就诊,经常规查体、超声及血人绒毛膜促性腺激素(HCG)和尿妊娠试验初诊为异位妊娠,经手术后病理检查确诊为输卵管绒毛膜癌和输卵管侵蚀性葡萄胎各1例;1例因下腹痛、自测尿妊娠试验阳性、突然晕倒诊断为异位妊娠,行左侧输卵管切除术后出现恶心呕吐、盆腔积血、血压升高,取手术标本病理会诊修正诊断为输卵管侵蚀性葡萄胎。3例确诊后经标准联合化疗治愈。结论特殊部位的GTD早期临床表现不典型,类似异位妊娠时易误诊,通过手术获取病理组织送检,重视监测血HCG变化,可避免延误诊治。     

导管超声诊断胃黏膜下病变的临床应用价值

目的探讨导管超声在诊断胃黏膜下病变中的临床应用价值。方法在胃镜引导下用10MHz超声微型探头对126个胃黏膜下隆起性病变行导管超声检查。结果导管超声共发现胃囊肿26个,平滑肌瘤27个,间质瘤19个,异位胰腺15个,胃癌1个,静脉瘤13个,黏膜炎性增生10个,脂肪瘤11个,胃外压迫4个。71个活检或术后病理检查与超声结果对照,超声误诊6个,诊断符合率为91．55％。结论导管超声能够明确显示胃黏膜下病变的来源、胃壁层次,较准确地提示病变性质,为临床诊断与治疗提供了非常重要的信息。     

Adenocarcinoma arising from an ectopic pancreas in the stomach

Ectopic pancreas is rare, being found in between 0.6 % and 15 % at autopsy. Heterotopic pancreas is usually an asymptomatic condition which is found incidentally at surgery or at autopsy. Occasionally, significant symptoms arise from complications, such as recurrent upper gastrointestinal bleeding, biliary or intestinal obstruction, or malignant degeneration. Malignant change is very rare. We report a case of malignant change (adenocarcinoma) in an ectopic pancreas in the stomach. In the literature, there are eight reported cases of malignant change in ectopic gastric pancreas. The prognosis in the other reported cases is unknown, but in our patient, the tumor was confined to the muscle of the stomach and there was no lymph node invasion.     

胰腺实性假乳头状瘤的超声特点与病理对照分析

目的 评价胰腺实性假乳头状瘤(SPTP)的超声表现特征与病理的相关性。方法 回顾性分析经手病理学检查证实的11例胰腺实性假乳头状瘤的超声影像资料,分析术前超声影像,包括肿块的位置、肿瘤囊性和实性成分、边缘、形态、直径、主胰管扩张、包膜和钙化等情况,并评价超声表现与病理的相关性。结果 11例SPTP患者均为女性,平均年龄34.5岁。肿瘤直径1.2～12cm；肿瘤位于胰腺体尾部6例,胰头2例,胰体2例,胰颈1例。6例呈囊实性,含纤维包膜,与周围正常胰腺分解清楚；5例呈实性,无包膜。4例显示钙化。多普勒显示4例含少量至中量血流。结论SPTP的超声表现反应其病理特征。青年女性胰腺囊实性肿瘤应考虑SPTP,但是较小的病变可能表现为实性,给诊断带来挑战。     

Intestinal intussusception caused by intestinal duplication and ectopic pancreas: A case report and review of literature

BACKGROUNDIntestinal intussusception caused by intestinal duplication and ectopic pancreas is extremely rare in the clinic and has not been reported previously.CASE SUMMARYA 29-year-old man was admitted to the hospital for chronic abdominal pain and bloating. The preoperative diagnosis was intestinal obstruction and intussusception. Then, laparotomy, partial small intestinal resection and extraintestinal decompression were performed. Postoperative pathology confirmed intestinal duplication and ectopic pancreas. After surgery, the patient recovered well with no complications. No recurrence was observed after more than 5 mo of follow-up.CONCLUSIONWe report a new case of a young male with intussusception caused by intestinal duplication and ectopic pancreas. Surgery is the main treatment for these conditions. This study aimed to raise awareness and provide information to improve the clinical management of this rare yet serious condition.     

Pancreatic heterotopia: a reappraisal and clinicopathologic analysis of 32 cases

A total of 32 histologically documented cases of heterotopic pancreas was found in a review of the records of the department of pathology at the Chang Gung Memorial Hospital between 1977 and 1987. This review was done to ascertain the clinical significance of this uncommon entity. In 14 patients (44%), the aberrant pancreatic tissue was symptomatic; in the other 18 (56%), it was found incidentally. In the symptomatic group, the heterotopic pancreatic tissue was found in a duplication cyst of the ileum in one patient, in the common bile duct in one, in a Meckel's diverticulum in four, in the stomach in three, in a congenital duodenal diaphragm in one, in the duodenum in three, and in the ileum in one. The majority of heterotopic pancreatic tissue in the asymptomatic group was encountered in the jejunum (15 patients). Symptoms were related to complications, including obstruction of the common bile duct, mucosal ulcer with hemorrhage, intussusception, and intestinal obstruction, but not to pathologic conditions of the pancreas itself, such as pancreatitis or pancreatic cyst or neoplasm. In all of the clinically significant cases, the clinical symptoms disappeared completely after surgical removal of the aberrant tissue. In 28 cases (87%), diagnosis was made by frozen section during operation. Preoperative diagnosis of aberrant pancreas was not made in any of the cases. Histologically, all cases showed pancreatic excretory ducts; in 31 cases (97%), exocrine glands were present, and in 27 cases (84%), islets of Langerhans were discernible. There was no relationship between symptoms and the presence of islets, acini, or ducts. Mallory's phosphotungstic acid-hematoxylin stain was used to demonstrate zymogen granules in the acinar cells, and insulin, glucagon, and somatostatin were demonstrated with the horseradish peroxidase-antihorseradish peroxidase immunocytochemical staining technique; islets of Langerhans were also identified. Technetium Tc 99m scintigraphy was used to detect the bleeding source in a Meckel's diverticulum and an enteric duplication associated with ectopic gastric mucosa.     

螺旋CT在矽肺诊断中的价值

目的探讨螺旋CT在矽肺诊断中的价值。方法回顾性对比分析32例已确诊为矽肺病人的X线胸片与螺旋CT的影像表现。结果32例中20例螺旋CT显示有多发且分布密集的小矽结节（直径％10mm）,而X线胸片显示12例,两者比较差异具有显著性（χ^2=4．00,P〈0．05）;直径〉10mm的融合结节和团块CT共检出12例,X线胸片检出9例,两者比较差异具有显著性（χ^=5．27,P〈0．05）。CT检出矽肺并发肺气肿11例,X线胸片检出6例;CT检出矽肺并发肺结核5例,X线胸片检出3例;CT检出矽肺并发纵隔和肺门淋巴结大或钙化21例,X线胸片检出15例。结论螺旋CT在矽肺大小结节的显示及并发症的检出上优于X线平片,对矽肺的正确、综合诊断具有重要价值。     

经阴道超声结合腹部加压法对异位妊娠的诊断

目的：探讨经阴道超声结合腹部加压法诊断异位妊娠的价值。方法回顾性分析以异位妊娠收入住院的157例患者的经阴道超声声像图特征,并与临床最终诊断结果相对照。结果157例患者中临床最后诊断为异位妊娠156例（包括宫内妊娠并异位妊娠1例）,宫内妊娠1例;经阴道超声结合腹部加压法检出异位妊娠154例,漏诊异位妊娠2例,检出宫内妊娠1例,检出异位妊娠敏感性为98.72%（154/156）、准确性为98.73%（155/157）。结论经阴道超声能够为临床诊断异位妊娠提供可靠的线索。     

胃肠道神经内分泌肿瘤的内镜误诊体会*

目的探讨胃肠神经内分泌肿瘤(GI-NETs)内镜诊治特点,减少误诊。方法收集2012年1月-2014年11月该院内镜诊断的84例神经内分泌肿瘤(NET),回顾性分析其白光内镜、超声内镜(EUS)、组织病理学及治疗后情况等特点,总结其中误诊病例特点。结果经内镜诊断NET 84例,最终经病理证实为NET 72例,12例内镜误诊为NET,误诊率达14.3%,12例分别为慢性炎症5例,异位胰腺2例,布氏腺增生1例,大肠增生性息肉1例,大肠静脉型血管瘤1例,大肠平滑肌瘤1例,转移性鳞癌1例。8例行EUS检查,均提示病灶来源黏膜下层,6例为低回声,1例偏高回声(布氏腺增生),1例混合回声(静脉型血管瘤)。结论 GI-NETs在内镜下有一定的特征性,但有部分病例表现可类似,经过更为细致的观察和必要的活检可增加诊断的准确率。     

彩色多普勒超声在异位妊娠和妊娠黄体中的诊断价值

目的探讨异位妊娠与妊娠黄体的经阴道超声表现,以提高其诊断符合率。方法回顾分析115例经手术及病理证实的异位妊娠患者和97例宫内早孕者妊娠黄体的经阴道超声表现。结果异位妊娠声像图表现为宫旁不均质包块,妊娠黄体声像图表现为卵巢内部或表面突出的不均质包块;彩色多普勒血流成像示115例异位妊娠患者血流呈环状者占1.74%(2/115),半环状者占26.96%(31/115),点/线状者占47.83%(55/115),未见血流信号者占23.48%(27/115);97例宫内早孕者妊娠黄体血流呈环状者占93.81%(91/97),半环状者占4.12%(4/97),点/线状者占2.07%(2/97)。异位妊娠患者较宫内早孕者妊娠黄体收缩期峰值流速低,阻力指数高,差异有统计学意义(P﹤0.05)。结论经阴道超声在异位妊娠与妊娠黄体的鉴别诊断中有重要价值。     

少见部位异位妊娠分析及误诊防范

目的探讨少见部位异位妊娠的临床特征及误诊原因。方法对2008-06—2011—03收治的33例少见部位异位妊娠进行回顾性分析。结果少见部位异位妊娠发生率占同期异位妊娠6．5％,以宫角妊娠最多见（9／33,占27．3％）,其余为输卵管间质部妊娠、卵巢妊娠（7／33,占21．2％）及子宫肌壁间妊娠（4／33,占12．1％）,术前误诊率63．6％。所有患者均行手术治疗,视术中情况行异位妊娠灶切除,33例均治疗成功,无手术并发症。结论少见部位异位妊娠临床表现不典型,术前诊断较困难,一旦怀疑本病应及早手术探查明确诊断。