Pancreatic heterotopia mimicking a common bile duct tumor

Hsu-Huan Tseng; Hsueh-Chien Chiang; Ping-Jui Su

doi:10.5946/ce.2024.196

Articles

Page Path: HOME > Clin Endosc > Volume 58(3); 2025 > Article

Image of Issue Pancreatic heterotopia mimicking a common bile duct tumor: Hsu-Huan Tseng¹, Hsueh-Chien Chiang¹, Ping-Jui Su²; Clinical Endoscopy 2025;58(3):474-475.
DOI: https://doi.org/10.5946/ce.2024.196
Published online: May 7, 2025

¹Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

²Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan, Taiwan

Correspondence: Ping-Jui Su Division of General Surgery, Department of Surgery, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan 704, Taiwan E-mail: cookieray1210@hotmail.com

Correspondence: Hsueh-Chien Chiang Department of Internal Medicine, National Cheng Kung University Hospital, No.138, Sheng Li Road, Tainan 704, Taiwan E-mail: n102122@mail.hosp.ncku.edu.tw

• Received: July 13, 2024 • Revised: August 19, 2024 • Accepted: August 20, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

505 Views
58 Download

prev next

Full Article

Download PDF

Supplementary Material
NOTES
REFERENCES

A 76-year-old woman presented to our hospital for dull epigastric pain and jaundice for several weeks. High fever obstructive jaundice and elevated lipase levels were detected. Abdominal computed tomography (CT) revealed one 0.5 cm soft tissue nodule in the middle common bile duct (CBD) with arterial-phase hyperenhancement (Fig. 1A). Endoscopic ultrasound (EUS) screening suggested uneven wall thickening of the CBD without channel dilation (Fig. 1B), indicating inflammation or dysplastic changes in the CBD. Following endoscopic retrograde cholangiopancreatography (ERCP) showed one 0.5 cm filling defect in the distal CBD (Supplementary Fig. 1A). Intraductal ultrasonography identified a 0.5 cm intraductal CBD nodule (Fig. 1C) with multiple peri-CBD lymphadenopathies (Fig. 1D). A plastic endoscopic retrograde biliary drainage tube was inserted (Supplementary Fig. 1B), her fever subsided, and jaundice improved.

A tissue biopsy during ERCP revealed atypical glands composed of hyperchromatic and pleomorphic tumor cells on a sclerotic fibrous background (Fig. 2A). Immunohistochemically, the tumor was positive for cytokeratin (Fig. 2B), S100P (Fig. 2C), and Ki-67 index (Fig. 2D), suggesting adenocarcinoma.

A pylorus-preserving pancreaticoduodenectomy was performed. Grossly, the distal CBD exhibited a stricture with wall thickening and fibrosis over the ampulla of Vater (Fig. 3A). Only cholangitis and a hyperplastic papillary duct were observed in the final CBD pathology (Fig. 3B).

Pancreatic heterotopia is characterized by the displacement of pancreatic tissues in various parts of the gastrointestinal tract during organogenesis. It can also be found throughout the gastrointestinal tract, as well as in the liver, biliary tree, and gallbladder. Although often asymptomatic, pancreatic heterotopia can cause symptoms depending on its size and location.¹ The biliary tract is an extremely rare location for pancreatic heterotopia, and biliary obstruction can occur,²^,³ which makes it very challenging to differentiate pancreatic heterotopia from a neoplasm of the bile duct before surgery. Chronic cholangitis causing inflammation can lead to a pathological diagnosis.⁴ Heterotopic pancreas should be considered in the differential diagnosis of small CBD tumors in patients with chronic pancreatitis and cholangitis. Additional cholangioscopy can be performed before surgery to obtain a more definitive diagnosis. Frequent imaging follow-up schedules can also avoid unnecessary emergent surgeries.

Supplementary Material

Supplementary Fig. 1. (A) Cholangiography of the endoscopic retrograde cholangiopancreatography. (B) An endoscopic retrograde biliary drainage was inserted into the common bile duct.

ce-2024-196-Supplementary-Fig-1.pdf

Supplementary materials related to this article can be found online at https://doi.org/10.5946/ce.2024.196.

Conflicts of Interest

The authors have no potential conflicts of interest.

Funding

None.

Acknowledgments

The patient’s consent was obtained.

Author Contributions

Conceptualization: HCC; Supervision: PJS; Writing–original draft: HHT, HCC; Writing–review & editing: all authors.

Fig. 1.

(A) Abdominal computed tomography demonstrated wall thickening of the common bile duct (CBD) and one 0.5 cm soft tissue nodule in the middle CBD with arterial-phase hyperenhancement. (B) EUS at duodenal bulb showed uneven wall thickening of CBD without channel dilation, indicating inflammation or dysplastic change of the CBD. (C) Intraductal ultrasonography identified the 0.5 cm intraductal CBD nodule at the distal CBD. (D) Intraductal ultrasonography showed multiple peri-CBD lymphadenopathy, and the maximal size of the lymph node was 1.2 cm.

Fig. 2.

(A) The tissue biopsy during endoscopic retrograde cholangiopancreatography showed atypical glands composed of hyperchromatic and pleomorphic tumor cells in a sclerotic fibrous background (one 0.5 cm soft tissue nodule in the middle common bile duct [CBD]). Immunohistochemically, the tumor is positive for (B) cytokeratin (uneven wall thickening of CBD without channel dilation), (C) S100P (intraductal CBD nodule at the CBD), and (D) Ki-67 index (multiple peri-CBD lymphadenopathy).

Fig. 3.

(A) The resected tissue showed distal common bile duct shows stricture with wall thickening and fibrosis over the ampulla of Vater. (B) The histopathology of the pancreatic head showed chronic pancreatitis with hyperplastic papillary duct lesion with atypia.

REFERENCES

1. Enea D, Busuioc B, Mocanu CA, et al. The strange case of a common bile duct obstruction: pancreatic heterotopia. J Gastrointestin Liver Dis 2023;32:432.Article PubMed PDF
2. de Ponthaud C, Daire E, Pioche M, et al. Cystic dystrophy in heterotopic pancreas. J Visc Surg 2023;160:108–117.Article PubMed
3. Sumiyoshi T, Shima Y, Okabayashi T, et al. Heterotopic pancreas in the common bile duct, with a review of the literature. Intern Med 2014;53:2679–2682.Article PubMed
4. Tsunoda T, Eto T, Yamada M, et al. Heterotopic pancreas: a rare cause of bile duct dilatation--report of a case and review of the literature. Jpn J Surg 1990;20:217–220.Article PubMed PDF

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Pancreatic heterotopia mimicking a common bile duct tumor

Clin Endosc. 2025;58(3):474-475. Published online May 7, 2025

DOI: https://doi.org/10.5946/ce.2024.196

XML Download

Figure

Pancreatic heterotopia mimicking a common bile duct tumor

Fig. 1. (A) Abdominal computed tomography demonstrated wall thickening of the common bile duct (CBD) and one 0.5 cm soft tissue nodule in the middle CBD with arterial-phase hyperenhancement. (B) EUS at duodenal bulb showed uneven wall thickening of CBD without channel dilation, indicating inflammation or dysplastic change of the CBD. (C) Intraductal ultrasonography identified the 0.5 cm intraductal CBD nodule at the distal CBD. (D) Intraductal ultrasonography showed multiple peri-CBD lymphadenopathy, and the maximal size of the lymph node was 1.2 cm.

Fig. 2. (A) The tissue biopsy during endoscopic retrograde cholangiopancreatography showed atypical glands composed of hyperchromatic and pleomorphic tumor cells in a sclerotic fibrous background (one 0.5 cm soft tissue nodule in the middle common bile duct [CBD]). Immunohistochemically, the tumor is positive for (B) cytokeratin (uneven wall thickening of CBD without channel dilation), (C) S100P (intraductal CBD nodule at the CBD), and (D) Ki-67 index (multiple peri-CBD lymphadenopathy).

Fig. 3. (A) The resected tissue showed distal common bile duct shows stricture with wall thickening and fibrosis over the ampulla of Vater. (B) The histopathology of the pancreatic head showed chronic pancreatitis with hyperplastic papillary duct lesion with atypia.

Fig. 1.

Fig. 2.

Fig. 3.

Pancreatic heterotopia mimicking a common bile duct tumor