Abstract
Pancreatic hamartoma is a rare benign tumor. Its preoperative diagnosis is challenging. We present a case of pancreatic hamartoma whose radiological-pathological correlation was evaluated in detail. A 53-year-old man was referred to our institution for diagnosis and treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance image revealed a 3.5 cm long tumor arising from the head of the pancreas with cystic and solid components, the latter of which was gradually and inhomogeneously enhanced in the delayed phase. Fluorodeoxyglucose (FDG) positron emission tomography/CT revealed slight FDG uptake in the solid component. Histologically, a number of pancreatic lobule-like structures, which were mainly composed of aggregates of small ducts embedded in concentric fibrous stroma with no apparent islets or peripheral nerves, were observed in the solid component, whereas multiple dilated ducts were seen in the cystic region. The solid component also contained a narrow area of edematous fibrous stroma with low vessel density, which corresponded with the unenhanced part in the inhomogeneously enhanced solid component. There was no remarkable cytological atypia throughout the mass. A pathological diagnosis of pancreatic hamartoma was made. The radiological findings agree well with the pathological findings. When a pancreatic tumor is of the solid type, preoperatively diagnosing it as pancreatic hamartoma is not possible. However, when a pancreatic tumor with cystic and solid components is inhomogeneously enhanced in contrast-enhanced studies, a diagnosis of pancreatic hamartoma can be considered.
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References
Addeo P, Tudor G, Oussoultzoglou E, Averous G, Bachellier P (2014) Pancreatic hamartoma. Surgery 156:1284-1285
Nahm CB, Najdawi F, Reagh J, Kaufman A, Mittal A, Gill AJ, Samra JS (2019) Pancreatic hamartoma: a sheep in wolf’s clothing. ANZ J Surg 89:E265-e267
Han YE, Park BJ, Sung DJ, Kim MJ, Han NY, Sim KC, Cho SB, Kim JY (2018) Computed tomography and magnetic resonance imaging findings of pancreatic hamartoma: A case report and literature review. Clin Imaging 52:32-35
Yamaguchi H, Aishima S, Oda Y, Mizukami H, Tajiri T, Yamada S, Tasaki T, Yamakita K, Imai K, Kawakami F, Hara S, Hanada K, Iiboshi T, Fukuda T, Imai H, Inoue H, Nagakawa T, Muraoka S, Furukawa T, Shimizu M (2013) Distinctive histopathologic findings of pancreatic hamartomas suggesting their “hamartomatous” nature: a study of 9 cases. Am J Surg Pathol 37:1006-1013
Kim HH, Cho CK, Hur YH, Koh YS, Kim JC, Kim HJ, Kim JW, Kim Y, Lee JH (2012) Pancreatic hamartoma diagnosed after surgical resection. J Korean Surg Soc 83:330-334
Pauser U, Kosmahl M, Kruslin B, Klimstra DS, Kloppel G (2005) Pancreatic solid and cystic hamartoma in adults: characterization of a new tumorous lesion. Am J Surg Pathol 29:797-800
Yamada Y, Mori H, Matsumoto S, Kiyosue H, Hori Y, Hongo N (2010) Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT. Abdom Imaging 35:163-171
Cappelli C, Boggi U, Mazzeo S, Cervelli R, Campani D, Funel N, Contillo BP, Bartolozzi C (2015) Contrast enhancement pattern on multidetector CT predicts malignancy in pancreatic endocrine tumours. Eur Radiol 25:751-759
Horton KM, Hruban RH, Yeo C, Fishman EK (2006) Multi-detector row CT of pancreatic islet cell tumors. Radiographics 26:453-464
Park HS, Kim SY, Hong SM, Park SH, Lee SS, Byun JH, Kim JH, Kim HJ, Lee MG (2016) Hypervascular solid-appearing serous cystic neoplasms of the pancreas: Differential diagnosis with neuroendocrine tumours. Eur Radiol 26:1348-1358
Cho HW, Choi JY, Kim MJ, Park MS, Lim JS, Chung YE, Kim KW (2011) Pancreatic tumors: emphasis on CT findings and pathologic classification. Korean J Radiol 12:731-739
Gore RM, Wenzke DR, Thakrar KH, Newmark GM, Mehta UK, Berlin JW (2012) The incidental cystic pancreas mass: a practical approach. Cancer Imaging 12:414-421
Buetow PC, Buck JL, Pantongrag-Brown L, Beck KG, Ros PR, Adair CF (1996) Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases. Radiology 199:707-711
Baek JH, Lee JM, Kim SH, Kim SJ, Kim SH, Lee JY, Han JK, Choi B-I (2010) Small (≤3 cm) Solid Pseudopapillary Tumors of the Pancreas at Multiphasic Multidetector CT. Radiology 257:97-106
Nagano H, Nakajo M, Fukukura Y, Kajiya Y, Tani A, Tanaka S, Toyota M, Niihara T, Kitazono M, Suenaga T, Yoshiura T (2017) A small pancreatic hamartoma with an obstruction of the main pancreatic duct and avid FDG uptake mimicking a malignant pancreatic tumor: a systematic case review. BMC Gastroenterol 17:146
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Toyama, K., Matsusaka, Y., Okuda, S. et al. A case of pancreatic hamartoma with characteristic radiological findings: radiological-pathological correlation. Abdom Radiol 45, 2244–2248 (2020). https://doi.org/10.1007/s00261-020-02425-6
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DOI: https://doi.org/10.1007/s00261-020-02425-6