RESUMO
BACKGROUND: Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death. CASE PRESENTATION: This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel's diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel's diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery. CONCLUSION: Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.
Assuntos
Coristoma , Mucosa Gástrica , Hemorragia Gastrointestinal , Divertículo Ileal , Humanos , Masculino , Hemorragia Gastrointestinal/etiologia , Mucosa Gástrica/patologia , Coristoma/complicações , Coristoma/cirurgia , Coristoma/patologia , Divertículo Ileal/complicações , Divertículo Ileal/cirurgia , Criança , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Diagnóstico Diferencial , Íleo/patologia , Íleo/cirurgia , Íleo/diagnóstico por imagem , Dor Abdominal/etiologia , Resultado do TratamentoRESUMO
Heterotopic pancreas is a rare congenital abnormality. The most common location is the stomach, duodenum and proximal jejunum. Rare locations are represented by the ampulla of Vater, esophagus, ileum, Meckel diverticulum, biliary tract, mesentery and spleen. We present the case of a 49 year old patient investigated for obstructive jaundice and diagnosed with an ampullar heterotopy of pancreas parenchyma, initially considered to be a malignant tumor. A Whipple pancreatoduodenectomy was performed with good postoperative evolution, the serum levels of bilirubin being normal after the first postoperative week.
Assuntos
Ampola Hepatopancreática , Coristoma , Icterícia Obstrutiva , Pâncreas , Pancreaticoduodenectomia , Humanos , Ampola Hepatopancreática/cirurgia , Icterícia Obstrutiva/etiologia , Icterícia Obstrutiva/cirurgia , Icterícia Obstrutiva/diagnóstico , Coristoma/complicações , Coristoma/cirurgia , Coristoma/diagnóstico , Pancreaticoduodenectomia/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Diagnóstico Diferencial , Masculino , Doenças do Ducto Colédoco/cirurgia , Doenças do Ducto Colédoco/diagnóstico , Doenças do Ducto Colédoco/complicaçõesRESUMO
Primary hyperparathyroidism (PHPT) is the most prevalent cause of hypercalcaemia, affecting 0.3% of the population. The only curative procedure is parathyroidectomy. Ectopic adenomas are challenging to localize and frequently result in persistent PHPT. This is a case report of a 29-year-old male patient who was diagnosed with PHPT prior to neck surgery and reoperated with bilateral neck exploration. However, the PHPT was not cured, until diagnostic CT with contrast had helped localizing a 1 cm ectopic parathyroid adenoma in the right horn of the thymus gland. The adenoma was then removed successfully.
Assuntos
Adenoma , Hiperparatireoidismo Primário , Neoplasias das Paratireoides , Tomografia Computadorizada por Raios X , Humanos , Masculino , Adulto , Neoplasias das Paratireoides/diagnóstico por imagem , Neoplasias das Paratireoides/cirurgia , Neoplasias das Paratireoides/patologia , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adenoma/patologia , Hiperparatireoidismo Primário/cirurgia , Hiperparatireoidismo Primário/diagnóstico por imagem , Hiperparatireoidismo Primário/etiologia , Coristoma/diagnóstico por imagem , Coristoma/cirurgia , Coristoma/patologia , ParatireoidectomiaRESUMO
Heterotopic hepatic tissue is a rare development anomaly, exhibiting diverse forms and locations. We present a case report of an asymptomatic woman in her 40s who had an 8 cm mass in the left hypochondrium detected on routine ultrasound, which was initially suspected to be a tumour. Further investigation revealed that the mass had a similar enhancement to the liver on gadoxetate disodium-enhanced MRI and presented a connection with the original liver via vascular pedicle, favouring the diagnosis of accessory liver lobe (ALL). Accurate differentiation of ALL from other abdominal masses poses a diagnostic challenge, potentially leading to misdiagnosis of malignant tumours and unnecessary interventions. Although usually small and asymptomatic, rarely they can present with acute complications, and cross-sectional techniques play an important role in enabling early diagnosis and management. Therefore, radiologists must raise awareness regarding ALL, their imagological findings, and diagnostic pathways, and understand potential associated complications.
Assuntos
Fígado , Imageamento por Ressonância Magnética , Humanos , Feminino , Diagnóstico Diferencial , Fígado/diagnóstico por imagem , Fígado/anormalidades , Fígado/patologia , Adulto , Ultrassonografia , Coristoma/diagnóstico , Coristoma/diagnóstico por imagem , Meios de Contraste , Gadolínio DTPARESUMO
The thymus derives from the third branchial pouch, which migrates to the mediastinum through the central region of the neck. During the migration, particles split off and develop separately. The prevalence of ectopic thymus is 20-40%. The purpose of this retrospective case series study was to investigate the prevalence of embryological tissue remnants in the central region, in patients treated for thyroid lesions. Between January 1 2018 and September 1 2020, 84 patients who underwent central neck dissection were selected. Clinicopathological data as age, gender, histopathological result and TNM stage were analyzed. Ectopic tissue in the central neck region was discovered in 28 cases. The prevalence of ectopic lesions showed increase in Stage I thyroid carcinomas. There was no significant correlation with patients' age, gender, or with the stage. We emphasize the clinicopathological role of ectopic tissues, which can occur in the central region of the neck.
Assuntos
Coristoma , Pescoço , Neoplasias da Glândula Tireoide , Humanos , Estudos Retrospectivos , Feminino , Masculino , Pescoço/patologia , Pessoa de Meia-Idade , Coristoma/patologia , Coristoma/epidemiologia , Adulto , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/cirurgia , Achados Incidentais , Timo/patologia , Esvaziamento Cervical , Idoso , Estadiamento de NeoplasiasRESUMO
Objective: To investigate the clinicopathological and genetic characteristics of neuromuscular choristoma-associated desmoid type fibromatosis (NMC-DF). Methods: The clinical morphological and immunohistochemical features of 7 NMC-DF cases diagnosed from January 2013 to January 2023 in Beijing Jishuitan Hospital were retrospectively analyzed. A series of neuromuscular choristoma and neuromuscular choristoma-associated desmoid type fibromatosis were evaluated for CTNNB1 mutations, and hotspot mutations for CTNNB1 were tested in 4 NMC-DF cases using Sanger sequencing. Results: The tumors were collected from 3 females and 4 males, aged 1 to 22 years (mean 7.1 years), involving the sciatic nerve (n=4), brachial plexus (n=2) or multiple nerves (n=1). The course of the disease spanned from 3 months to 10 years. Two cases were recurrent tumors. All the 7 NMC cases showed endoneurial intercalation of mature skeletal muscle fibers among the peripheral nerve fascicles, and the histologic features of the NMC-DF were strikingly similar to the conventional desmoid-type fibromatosis. By immunohistochemistry, all NMC and NMC-DF cases showed aberrant nuclear staining of ß-catenin (7/7), the muscle cells in NMC were intensely immunoreactive for desmin, and the admixed nerve fibers were highlighted by NF and S-100 (7/7). Four NMC and NMC-DF had CTNNB1 mutations, 3 c.121A>G (p.T41A) and 1 c.134C>T (p.S45F). Follow-up of the 7 cases, ranging from 22 to 78 months, showed tumor recurrence in 2 patients at 3 and 8 months respectively after the first surgical resection, of which 1 patient underwent above-knee amputation. No recurrence occurred in other cases with tumor excision and neurological reconstruction surgery. There was no metastasis occurred in the 7 cases. Conclusions: NMC is a rare congenital lesion with differentiated mature skeletal muscle tissue found in peripheral nerve fascicles, and approximately 80% of patients with NMC develop a soft tissue fibromatosis. CTNNB1 mutation in the Wnt signaling pathway may be involved in the pathogenesis of NMC and NMC-DF, and S45F mutations seems to have a higher risk of disease progression.
Assuntos
Coristoma , Fibromatose Agressiva , Mutação , beta Catenina , Humanos , beta Catenina/genética , beta Catenina/metabolismo , Fibromatose Agressiva/genética , Fibromatose Agressiva/patologia , Fibromatose Agressiva/metabolismo , Fibromatose Agressiva/cirurgia , Masculino , Feminino , Criança , Estudos Retrospectivos , Lactente , Adolescente , Pré-Escolar , Coristoma/patologia , Coristoma/genética , Adulto Jovem , Plexo Braquial/patologia , Plexo Braquial/cirurgia , Nervo Isquiático/patologiaRESUMO
The gradually progressive solitary cystic-solid mass of chest CT scans is highly suggestive of lung cancer. We report a case of a 29-year-old woman with a persistent cystic-solid lesion in the right upper lobe. A chest CT scan showed a 35 mm × 44 mm × 51 mm focal cystic-solid mass in the anterior segment of the right upper lobe. The size of lesion had increased over 3 years, especially for the solid component. The right upper lobe pneumonectomy was performed. Postoperative pathological examination showed placental transmogrification of the lung, which is a rare cause of pulmonary cystic lesion.
Assuntos
Pneumonectomia , Tomografia Computadorizada por Raios X , Humanos , Feminino , Adulto , Tomografia Computadorizada por Raios X/métodos , Pneumonectomia/métodos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/cirurgia , Diagnóstico Diferencial , Gravidez , Pneumopatias/cirurgia , Pneumopatias/patologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/diagnóstico , Cistos/cirurgia , Cistos/patologia , Cistos/diagnóstico por imagem , Cistos/diagnóstico , Coristoma/cirurgia , Coristoma/patologia , Coristoma/diagnóstico , Coristoma/diagnóstico por imagem , Resultado do Tratamento , Placenta/patologia , Placenta/diagnóstico por imagemRESUMO
BACKGROUND: Ectopic prostatic tissue in female patients is rare. It is theorized that the presence of prostatic tissue in female patients is likely a Wolffian remnant or transformation of hormonally mediated tissue of the uterus, cervix, Skene's gland, and, rarely, periurethral tissue. Due to the increase in the use of testosterone and gender-affirming therapies, it is important to understand the role of testosterone in mediating the presence of ectopic prostatic tissue. CASE: We present a case of ectopic prostatic tissue in a urethral diverticulum in a female patient with exposure to testosterone hormone therapy and review the literature on this finding. CONCLUSION: Although rare, ectopic prostatic tissue should be considered in the differential diagnosis of anterior vaginal cysts, especially in the setting of testosterone supplementation.
Assuntos
Coristoma , Divertículo , Próstata , Doenças Uretrais , Feminino , Humanos , Testosterona/uso terapêuticoRESUMO
Thymoma is a rare malignancy with usual location in the antero-superior mediastinum. Ectopic cervical thymoma (ECT) is an extremely rare tumor that originates from ectopic tissue, and is caused by the aberrant migration of the embryonic thymus. Our patient was a 56-year-old man who had a nodular lesion in the neck for several years. Computed tomography and Enhanced magnetic resonance imaging were performed. He underwent surgery, and a histological examination resulted in a diagnosis of type AB thymoma.
Assuntos
Coristoma , Imageamento por Ressonância Magnética , Timoma , Neoplasias do Timo , Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade , Timoma/cirurgia , Timoma/diagnóstico , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Coristoma/cirurgia , Coristoma/diagnóstico , Coristoma/patologia , Coristoma/diagnóstico por imagem , Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/diagnóstico por imagemRESUMO
The study aims to summarize the clinical characteristics of patients with ectopic gastric mucosa in the small intestine, comparing clinical presentation differences between domestic and foreign patients through literature review. The clinical characteristics of cases diagnosed with ectopic gastric mucosa in the small intestine at Peking Union Medical College Hospital from January 2000 to January 2024 were retrospectively analyzed. By searching databanks, such as PubMed, EMBASE, the Cochrane Library, Wanfang, VIP, CNKI, and etc (the inclusion period was from the establishment of the database to January 1, 2024). The literature review was conducted on ectopic gastric mucosa in the small intestine. A total of 10 cases were included, all male, age [M (Q1, Q3)] was 27 (13-69) years old. Gastrointestinal bleeding was the first manifestation in most cases, with severe cases leading to hemorrhagic shock. Abdominal CT indicated local intestinal wall thickening and luminal narrowing in 3 cases. Four cases lesions were located at the beginning of the jejunum and 6 lesions were located in the end segment of ileum. All cases underwent local lesion resection, with postoperative pathology confirming ectopic gastric mucosa. Symptoms disappeared postoperatively, with a follow-up period of 0.5-3.0 years. Literature review indicates that the main clinical manifestation of gastric mucosa ectopia in the small intestine in China is gastrointestinal bleeding, while foreign patients are often complicated with intestinal duplication and intussusception, with abdominal pain and vomiting as the primary and main symptoms. The occurrence rate of intestinal obstruction in female patients, both domestically and abroad, is higher than that in male patients. The occurrence rate of ileal lesions with intestinal obstruction and small intestinal duplication is higher than that of duodenal lesions in both domestic and foreign patients. Local small intestine resection is an effective treatment method with generally good prognosis. Ectopic small intestinal mucosa is relatively rare, with symptoms of gastrointestinal bleeding and intestinal obstruction being common presentations, which can serve as one of the differential diagnoses for unexplained gastrointestinal bleeding.
Assuntos
Coristoma , Mucosa Gástrica , Hemorragia Gastrointestinal , Intestino Delgado , Humanos , Mucosa Gástrica/patologia , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Idoso , Hemorragia Gastrointestinal/etiologia , Adulto Jovem , Estudos Retrospectivos , Feminino , ChinaRESUMO
When a neuroendocrine tumor with abundant blood flow is located in the pancreatic tail, it is difficult to distinguish it from accessory spleen. The patient was a 71-year-old woman who was admitted with impaired consciousness and hypoglycemia, raising suspicion of insulinoma. The selective arterial calcium injection test suggested a lesion in the pancreatic tail. Contrast-enhanced computed tomography and magnetic resonance imaging (MRI) showed a mass in the splenic hilum; however, its continuity with the pancreas was unclear. Contrast-enhanced MRI using super paramagnetic iron oxide (SPIO) showed no SPIO uptake in the splenic hilar mass. SPIO contrast-enhanced MRI is considered useful for differentiating pancreatic endocrine tumors from paraspleen tumors.
Assuntos
Insulinoma , Imageamento por Ressonância Magnética , Neoplasias Pancreáticas , Humanos , Insulinoma/diagnóstico por imagem , Insulinoma/diagnóstico , Feminino , Idoso , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Diagnóstico Diferencial , Meios de Contraste , Baço/diagnóstico por imagem , Baço/patologia , Compostos Férricos , Coristoma/diagnóstico por imagem , Coristoma/patologiaRESUMO
Ectopic goitre, presenting as an isolated thoracic mass without connection to the main thyroid gland enlargement, is a rare occurrence. We describe a case where a patient reported persistent dry cough and back pain for 1 year, along with throat discomfort unresponsive to medication. A 2×1 cm swelling was noted over the right anterior aspect of the neck. Extensive evaluation, including chest X-rays and contrast-enhanced CT of the thorax, revealed a mediastinal mass suggestive of an ectopic thyroid.This case presents a distinctive scenario involving the simultaneous presence of ectopic mediastinal and cervical thyroid lesions. Both were effectively managed using a minimally invasive approach, combining video-assisted thoracic surgery for the excision of the mediastinal mass and a bilateral axillo-breast approach for the cervical lesion in a single procedure. This approach yielded minimal morbidity, aesthetically pleasing outcomes and rapid recovery. Remarkably, such a case has not been previously documented in the available literature.
Assuntos
Cirurgia Torácica Vídeoassistida , Tireoidectomia , Humanos , Tireoidectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Feminino , Pescoço/cirurgia , Pescoço/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Coristoma/cirurgia , Coristoma/diagnóstico por imagem , Glândula Tireoide/cirurgia , Glândula Tireoide/diagnóstico por imagemRESUMO
OBJECTIVE: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.
Assuntos
Coristoma , Pâncreas , Humanos , Estudos Retrospectivos , Coristoma/cirurgia , Coristoma/diagnóstico , Masculino , Feminino , Pâncreas/cirurgia , Criança , Pré-Escolar , Lactente , Adolescente , Divertículo Ileal/cirurgia , Divertículo Ileal/diagnósticoRESUMO
BACKGROUND: Ectopic cervical thymoma (ECT) is an extremely rare tumor, especially in association with myasthenia gravis (MG). CASE PRESENTATION: We report a case of myasthenia gravis with an ectopic thymoma in the neck, whose myasthenic symptoms significantly improved after complete removal of the mass. A 55-year-old woman with generalized myasthenia gravis (MG) experienced worsening neuromuscular weakness after abruptly discontinuing pyridostigmine. Testing revealed acetylcholine receptor-antibody (AChR-Ab) positivity and a cervical mass initially thought to be thyroid or parathyroid was identified as a thymoma, type A. Post-surgery and radiation therapy, her myasthenic symptoms improved significantly with less prednisone and pyridostigmine requirements over time and no need for additional immunotherapies. CONCLUSIONS: Diagnosing ECTs is challenging due to rarity, atypical locations, and inconclusive fine needle aspiration cytology (FNAC) results, often misinterpreted as thyroid or parathyroid lesions. As proper management of patients with MG, including thymectomy, offers favorable clinical outcomes such as significant improvement in myasthenic complaints and reduced immunosuppressive medication requirements, clinicians should be vigilant of the ectopic locations of thymomas to ensure timely diagnosis and intervention.
Assuntos
Miastenia Gravis , Timoma , Humanos , Feminino , Miastenia Gravis/complicações , Miastenia Gravis/diagnóstico , Pessoa de Meia-Idade , Timoma/complicações , Timoma/diagnóstico , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Coristoma/complicações , Coristoma/patologiaRESUMO
Microscopic heterotopic extraovarian sex cord-stromal proliferations were first reported in the literature in 2015 by McCluggege. Afterwards, few similar cases have been described. Herein, we report the fourteenth case of microscopic heterotopic sex cord-stromal proliferation and the third case sited in the pelvic peritoneum. The clinical history of these rare cases suggests their benign nature. Knowledge of this histological pattern is important for differential diagnoses such as malignant pathologies and metastatic diseases.
Assuntos
Tumores do Estroma Gonadal e dos Cordões Sexuais , Feminino , Humanos , Pessoa de Meia-Idade , Proliferação de Células , Coristoma/patologia , Tumores do Estroma Gonadal e dos Cordões Sexuais/patologiaRESUMO
Transverse testicular ectopia (TTE) is an infrequent ectopic testis where both testes descend via the same inguinal canal, located in the same hemiscrotum, and augments the risk of developing testicular tumours. Type II TTE is accompanied by persistent Müllerian duct syndrome, where the Müllerian structures persist for various reasons. Here, we present a case of an adult in his early 30s, who presented with a right testicular swelling and was diagnosed as type II TTE and testicular mixed germ cell tumour after surgery. We could find only 13 similar cases of TTE and testicular tumours in the literature. Our case highlights the importance of clinical acumen with detailed history, meticulous clinical examination, radiological investigations and a detailed pathological examination while dealing with such sporadic presentations.