CLINICAL, HISTOPATHOLOGICAL, IMMUNOHISTOCHEMICAL AND THERAPEUTICAL ASPECTS OF THE HETEROTOPIC ACCESSORY PANCREAS IN THE PROXIMAL GASTROINTESTINAL TRACT.

This study presents the morphological, morphopathological and immunohistochemical aspects of digestive heterotopic accessory pancreas (performed in 2^nd Surgical Clinic of .Sf. Spiridon. Emergency Hospital from Iasi between jan. 1986 and dec. 2011) Results: 30 patients of this retrospective study (19 males/63,3% and 11 females/36,6%) aged between 23 and 78 years were grouped (regarding the diagnosis circumstances) in: A group, clinical symptomatic cases (5 patients/16,6%) with obstructive prepyloric polypoid tumors that required antrectomy and gastroduodenal anastomosis; group B, coincidental cases (19 patients/ 63,3%) - 14 patients of group B (73,6%) with pyloroduodenal stenosis and the remaining cases (26,3%) with severe upper-GI bleeding that required a subtotal gastric resection (3 patients) or antrectomy (2 cases) and group C, incidental cases (6 patients/20,0%) in which the histopathological diagnosis of a jejunal pancreas heterotopy occurred after an extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. On direct or endoscopic exploration of clinical manifested cases, the lesion was prepyloric nodular or polipoid tumor, sized between 2.5 - 4 × 2.0 - 3.5 × 1.0 - 2.0 cm and had a yellowish colour on the sectioned aspect. Based on the histological classification of Heinrich H. the accesory heterotypic pancreatic tissues may be classified as: type I - ducts, acini and pancreatic islets in 40,0% cases, type II - ducts and acini in 43,3% cases and type III - exclusively with ducts in 16,6% cases. In 76,6% cases which means 23 patients, the pancreatic heterotopy was localized in mucosal and submucosal layers; in 16,6% of cases /5 patients - intramucosal and in 6,3% /2 patients the location was in the subserous layer (based on immunomarkers assessment for synaptophysine, EMA, CK 7 on the epithelium of the ducts and acini of digestive heterotopic accessory pancreas). Conclusion: The most frequent location of heterotopic accessory pancreas is the digestive one. The reports showed an incidence of 70-90% of cases. [ABSTRACT FROM AUTHOR]