| PART? Analysis of clinical characteristics of ectopic pancreas of gastrointestinal tractBackground and objectiveRecently,the detection rate of ectopic pancreas(EP)is increasing year by year,clinical symptoms are not significantly specific,most patients are asymptomatic,and the main clinical manefestations are abdominal pain,abdominal distention,gastrointestinal bleeding,etc.The previous literature is mostly case reports and the study sample is small.Therefore,this study aims to explore the clinical characteristics of ectopic pancreas with a relatively large sample.Materials and methodsThis study collected and analyzed the clinical data of 209 patients with ectopic pancreas treated at the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2018.The pathological diagnosis was confirmed.The clinical manifestations of ectopic pancreas were analyzed retrospectively.Location,endoscopic and ultrasound endoscopy performance,treatment methods and outcome were collected and analyzed.Categorical data are expressed as n&percentage,and continuous variables with a skewed distribution are expressed as median(range).And data were analyzed by SPSS 19.0(SPSS Inc.,Chicago,IL,USA).P<0.05 was considered as statistical significance.ResultsPatients with gastrointestinal ectopic pancreas were increasing yearly.Among the 209 patients with gastrointestinal ectopic pancreas,106 were male(50.72%),103 were female(49.28%),and the gender ratio of male and female patients was 1.03:1.Age range was 40(6-77)years old.Main symptoms included abdominal pain(41 cases,19.62%),abdominal distension(43 cases,20.57%),anorexia(16 cases,7.66%),etc.,and most patients had no obvious clinical symptoms(30 Cases,14.35%).Of the 209 confirmed ectopic pancreatic cases,1(0.48%)was located in the esophagus,159(76.08%)was located in the stomach,and 13(6.22%)were located in the duodenum.Among them,24(11.48%)were located in the jejunum and 12(5.74%)were located in the ileum.Of the 159 patients with gastric ectopic pancreas,128 were located in the gastric antrum(80.50%),and 15 were in the gastric body(9.43%).There were 6 cases(3.77%)of the gastric angle and 10 cases(6.29%)in the gastrinc fundus.Of the 159 cases of gastric lesions,only 45(26.95%)of them showed umbilical depressions or lesion openings at the top of the lesion.The surface of the lesion was smooth and the color was the same as the gastric mucosa.The lesion of 8 cases(4.79%)showed congestion and edema,3 cases(1.80%)showed ulcer,and 5 cases(2.99%)showed slightly rough.Most of the lesions originated from the submucosa(85 cases,62.96%)and propria muscularis(35 cases,25.93%).Hypoecho(77 cases,57,04%)and intermediate echo(51 cases,37.78%)were more common.The lesion boundaries were definite(130 cases,96.3%),and only 5 cases(3.7%)were indefinit.Of the 172 cases of gastroduodenal pancreas,153 were given endoscopic treatment.36 patients with small intestinal ectopic pancreas,including 19 males and 17 females,male:female=1.12:1,aged 45 years(25-72 years),including 24 in jejunum and 12 in ileum.All patients with intestinal lesions underwent surgical treatment.Conclusions1.The gastrointestinal ectopic pancreas are often present in the stomach,duodenum,and small intestine,and the gastric antrum is the most common location;there is no specific endoscopic characteristics of ectopic pancreas,and the proportion of patients with umbilical depression at the top is few;2.Endoscopic ultrasonography shows that the ectopic pancreas often originates from the submucosa,and mixed echoes are more common;3.Upper gastrointestinal ectopic pancreas can be treated endoscopically,and small bowel lesions are often given surgery.PART ?Comparative analysis of clinical features of gastric ectopic pancreas and gastric stromal tumorBackground and objectiveGastrointestinal ectopic pancreas is most common in the stomach,although umbilical depressions can be seen at the top of the lesion under endoscopy,this feature can be observed in only a small number of patients,which is difficult to distinguish from gastric stromal tumors.Gastric stromal tumor is also a common submucosal mass of the stomach,which is potentially malignant and needs to be diagnosed and treated as soon as possible,so the differential diagnosis of the two is very important.Previous reports have reported a small sample study and the conclusions are not reliable.Therefore,this study aims to use a larger sample and analyze the clinical characteristics and endoscopic characteristics,in order to explore the differences between the both diseases,to provide a certain clinical theory for differential diagnosis in clinic.Materials and methodsA total of 156 patients with gastric ectopic pancreas and 248 patients with gastric stromal tumor treated in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2018 were included in this study.The clinical manifestations,lesions location,endoscopic and ultrasound endoscopic performance characteristics,treatment methods and outcome follow-up,etc were collected and analyzed.Categorical data are expressed as n&percentage,and continuous variables with a skewed distribution are expressed as median(range).And data were analyzed by SPSS19.0(SPSS Inc.,Chicago,IL,USA).P<0.05 was considered as statistical significance.ResultsThe clinical characteristics of the two groups of patients had no significant statistical differences,and the clinical symptoms were not specific.The main symptoms included abdominal pain,abdominal distension,anorexia.Asymptomatic patients were common also.The lesions can occur in various location of the stomach,but gastric ectopic pancreas mostly occured in the gastric antrum,and gastric stromal tumors mostly occur in gastric body and fundus(both.P<0.05);umbilical depressions could be seen on the surface of gastric ectopic pancreas.The gastric ectopic pancreas lesions were smooth,while the surface of the gastric stromal tumor was smooth or eroded(all P<0.05).A total of 130 patients with gastric ectopic pancreas and 225 patients with gastric stromal tumors underwent ultrasound endoscopy.The results shown that the gastric ectopic pancreas mainly originated from the submucosa of the stomach(85 cases,65.38%),followed by the mucosa layer and the muscularis mucosa;the gastric stromal tumors originated from the muscularis mucosa(175 cases,77.78%)(P<0.05)The growth pattern of gastric ectopic pancreas is mainly intramuscular(102 cases,78.46%),while gastric stromal tumors are mainly intramuscular,intraluminal and extraluminal(P<0.05).The ratio of long to short diameter was higher in gastric ectopic pancreas than that of gastric stromal tumors(1.86 ± 0.24 vs 1.12 ± 0.18,P<0.05).Endoscopic treatment was the main treatment for gastric ectopic pancreas(147 cases,94.23%),but surgical and endoscopic treatment were often used for the patients with gastric stromal tumors(P<0.05).Conclusions1.The clinical characteristics of patients with gastric ectopic pancreas and gastric stromal tumors are not significantly different;gastric ectopic pancreas is mostly located in the gastric antrum,and gastric stromal tumors are mostly located in the gastric body and fundus;2.Intramuscular growth pattern and mixed hypoecho is often seen in patients with gastric ectopic pancreas,while intramuscular,intraluminal and extraluminal pattern and uniform hypoecho is often in patients with gastric stromal tumors;gastric ectopic pancreas mostly originates from the submucosa,and gastric stromal tumors mostly originate from the muscularis mucosa and the muscularis propria;the ratio of long:short diameter of gastric ectopic pancreas is higher than that of gastric stromal tumor measured by ultrasound endoscope;3.The treatment of gastric ectopic pancreas is mainly endoscopic,while the treatment of gastric stromal tumor is mainly surgical and endoscopic.PART ?Analysis of clinical characteristics of jejunal ectopic pancreas and correlation between pathology and CT performanceBackground and objectivePreoperative diagnosis of ectopic pancreas is difficult,but its radiological and endoscopic characteristics could help the diagnosis.Barium contrast examination shows a circular defect with a central depression,but the incidence is low;enhanced CT does not have a clear diagnosis value,only showing thickening of the intestinal wall or mucosal layer.Especially the diagnosis of jejunal ectopic pancreas is more difficult,and small intestine endoscopy is not widely used in clinic,so the diagnosis of the disease still needs the assistance of imagine.So,the purpose of this study is to explore the characteristics of jejunal ectopic pancreas cases and the correlation between pathology and CT manifestations,to provide theoretical support for clinical diagnosis of jejunal ectopic pancreas.Materials and methodsThis study collected clinic data of 20 patients with jejunal ectopic pancreas who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2018.The clinical characteristics,pathological diagnosis,CT manifestations,and other data were collected and analyzed.t test was used;Categorical data are expressed as n&percentage,and continuous variables with a skewed distribution are expressed as median(range).And data were analyzed by SPSS 19.0(SPSS Inc.,Chicago,IL,USA).P<0.05 was considered as statistical significance.ResultsAll of 20 patients with jejunal ectopic pancreas underwent CT examination and found corresponding mass lesions.The main symptoms were abdominal pain,abdominal distension,and melena,and 6 of them were asymptomatic.Lesions were often in proximal jejunum(15 cases,75%).The diameter was 2.32 ± 0.63cm(0.8cm-3.5cm),and the common shape is round(8 cases,40%).Most lesions have clear boundaries(18 cases,90%)The lesion itself was lobular(17 cases,85%),with different growth patterns.Duct-like structures were observed in only 5 cases of lesions,and no depression was seen on the surface of the lesions in this study.Compared with the normal position pancreas,13 patients(65%)with jejunal ectopic pancreatic had iso-enhancement pattern during the arterial phase,and most patients(8 patients,40%)showed hyper-enhancement or iso-enhancement(8 patients,40%)during the portal phase.Compared with the jejunum,most lesions were significantly strengthened during the arterial phase(16 cases,80%)and portal vein phase(18 cases,90%).The ocular and microscopic features of the lesions in patients with jejunal ectopic pancreas are:pale yellow,with or without white lesions,multiple lobules were visible,no bleeding or cystic lesions were seen,and 15(75%)patients had microcatheter communication between the ectopic pancreas and jejunum.Microcomposition,of which ductal predominace were 5 cases(25%),and 15 cases(75%)were acinar predominace.Acinar predominace was associated hyper-enhancement and iso-enhancemet in artery phase,while ductal predominace was associated with hypo-enhancement in portal phase.Conclusions1.Jejunal ectopic pancreas were often in proximal jejunum,the diameter is often less than 3cm,which is oval or flat,and multiple leaflet-like structures can be seen on CT;2.Jejunal ectopic pancreas growth pattern were various and the duct-like structure is rare in CT;3.The CT enhancement pattern is similar to the normal pancreas,but it is related to the structural composition of the lesion. |
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