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[Ectopic pancreas. À̼ҼºÃéÀå] - ðû

1. Introduction

2. Endoscopic findings - À§Ã¼ÇϺΠ¼Ò¸¸ SMT ¾ç»óÀÇ ectopic pancreas

3. Ectopic pancreas of the cardia

4. Endoscopic treatment of ectopic pancrea

5. Small bowel ectopic pancreas ¼ÒÀå À̼Ҽº ÃéÀå

6. Role of MRI in the evaluation of ectopic pancrea MRIÀÇ ¿ªÇÒ

7. FAQ

8. References


1. Introduction

1) Location of heterotopic pancreas
- According to the analysis of 431 published cases
- 30.5% in the duodenum, 26.5% in the stomach, 16.5% in the jejunum, 5.8% in the ileum, 5.3% in the Meckel's diverticulum.
- 95% of heterotopic pancreatic lesions found in the stomach
- located in the pylorus or in the antrum GC within 5 to 6 cm from the pylorus esophagus, cystic duplicates of ileum, mesentery, omentum, colon, gall bladder, cystic duct and choledochus, spleen, liver, lymph nodes, urinary bladder, lungs and Fallopian tubes.

2) Predominantly intramural masses
- 75% are submucosa, and the other are intramuscular or subserosal.

3) The macroscopic appearance of heterotopic pancreas is a benign-appearing firm submucosal mass on a broad basis, sharply circumscribed from the surrounding tissue. The distinguishing feature of heterotopic pancreas is the central umbilication representing probably a rudimentary excretory duct (present in less than 50 % of cases).

4) The size of heterotopic pancreas may vary from microscopic to few centimetres.

5) À§ÀÇ ectopic pancreas´Â À§³»½Ã°æ Á¶Á÷°Ë»ç·Î È®ÀεǴ °æ¿ìµµ ÀÖ°í È®ÀεÇÁö ¾Ê´Â °æ¿ìµµ ÀÖ½À´Ï´Ù.

6) Acini´Â ¾ø°í duct¸¸ ÀÖ´Â °æ¿ì´Â adenomyoma¶ó°í ºÒ¸®±âµµ ÇÕ´Ï´Ù.

Distal antrumÀÇ mass·Î ³»¿øÇϼ̽À´Ï´Ù. Submucosal tumor ¾ç»óÀÌ°í Áß¾ÓÀÌ ´Ù¼Ò ÇÔ¸ôµÇ¾î ÀÖ¾ú½À´Ï´Ù. Á¶Á÷°Ë»ç¸¦ ÇÏ¿´°í ectopic pancreas·Î È®ÀεǾú½À´Ï´Ù.

¿ÞÂÊ Á¶°¢¿¡´Â Á¡¸·ÇÏÃþ¿¡, ¿ìÃø Á¶°¢¿¡´Â Á¡¸·Ãþ¿¡ pancreas Á¶Á÷ÀÌ º¸ÀÔ´Ï´Ù.

À§Ã¼ÇϺΠÈĺ®ÀÇ Á¡¸·ÇÏÁ¾¾çÀ¸·Î wedge resectionÀ» ÇÏ¿© ectopic pancreas·Î È®ÀÎÇÏ¿´½À´Ï´Ù.

Deep submucosal layer¿Í ±ÙÀ°Ãþ »çÀÌ¿¡ pancreas Á¶Á÷ÀÌ º¸ÀÔ´Ï´Ù.

ÀϺΠsuperficial submucosal layer³ª deep mucosal layer¿¡ ÃéÀå Á¶Á÷ÀÌ º¸À̱â´Â ÇÏÁö¸¸ (°ËÀº È­»ìÇ¥) ³»½Ã°æ Á¶Á÷°Ë»ç¿¡¼­ ÀÌ ºÎÀ§¸¦ targeting ÇÒ ¼ö´Â ¾ø½À´Ï´Ù. ¾ÆÁÖ ¾î¼´Ù ¿ì¿¬È÷ ³ª¿À´Â °æ¿ì°¡ ÀÖÀ» »ÓÀÔ´Ï´Ù.

Singapore Med J 2014ÀÇ ¼³¸íÀ» ¿Å±é´Ï´Ù.

Ectopic or heterotopic pancreas is a relatively rare finding, with a reported incidence of 0.55% - 13.70% at autopsy. The stomach, duodenum and the proximal jejunum are the most common sites. Other less commonly reported sites in the gastrointestinal tract are the ileum, Meckel¡¯s diverticulum, oesophagus, colon, mesentery and omentum. Ectopic pancreatic tissue has also been reported in the liver, gallbladder, spleen, common bile duct, retroperitoneum, umbilicus, lymph nodes, and in extra-abdominal locations such as the lungs and mediastinum.

By four to five weeks of gestation, the pancreas is formed by the ventral and dorsal buds of the endodermal lining of the duodenum. The dorsal bud grows more rapidly than the ventral bud. The dorsal bud forms the upper part of the head, body and tail of the pancreas, while the ventral bud forms the lower part of the head and uncinate process. The ventral bud rotates toward the dorsal bud and finally fuses with the dorsal bud. During the process of rotation, the ventral and dorsal buds of the pancreas are in close proximity to the stomach and duodenum. This may result in the incorporation of pancreatic primordial germ cells into the bowel loops, which may potentially develop into pancreatic tissue later on. Rarely, one of the buds may get detached and carried along the long axis of the bowel, thus explaining the site of ectopic pancreas remote from the normal anatomical location. Another theory of the origin of ectopic pancreas is the differentiation of totipotent endodermal cells into pancreatic tissue in the intestinal tract, as well as in extra-abdominal locations. This may explain the presence of pancreatic tissue in the lungs, mediastinum and retroperitoneum.

Ectopic pancreas can be classified according to the Heinrich classification. Type I ectopic pancreas contains all the elements of normal pancreatic tissue such as acini, ducts and islet cells. Type II contains pancreatic acini and ducts without islet cells, while only pancreatic ducts are seen in Type III.

Most cases of ectopic pancreas are incidentally diagnosed during gastroduodenoscopy, EUS or CT performed for other reasons, as in our case. However, patients with ectopic pancreas may be affected by the inflammatory or neoplastic process, similar to a normal pancreas. Patients with ectopic pancreas may present with complications such as bleeding, stricture, ulceration, pancreatitis, pseudocyst and malignant transformation. Most ectopic pancreas measure less than 2 cm in size, but can also be as large as 5 cm. Ectopic pancreas occurring in the gastrointestinal tract is usually seen in the submucosal layer, making it difficult to differentiate from gastrointestinal stromal tumour (GIST).


2. Endoscopic findings. ³»½Ã°æ ¼Ò°ß

ÇÑ ¾Öµ¶ÀÚ°¡ º¸³»ÁֽŠ»çÁø

³»½Ã°æ Á¶Á÷°Ë»ç·Î È®ÀÎµÈ ectopic pancreas

³»½Ã°æ Á¶Á÷°Ë»ç·Î È®ÀÎµÈ ectopic pancreas

7³â°£ °æ°ú°üÂû Áß º¯È­°¡ ¾ø¾úÀ½. Ectopic pancreas·Î ÃßÁ¤

Stomach, subtotal gastrectomy: early gastric carcinoma
1. Location : lower third, center at antrum and lesser curvature
2. Gross type : EGC type IIa+IIc
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : intestinal
5. Size : 0.9x0.8x0.3 cm
6. Depth of invasion : extension to submucosa (sm3) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal, 4.6 cm; distal, 3.5 cm
8. Lymph node metastasis : no metastasis
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
Heterotopic pancreas in the prepyloric antrum of anterior wall


[À§Ã¼ÇϺΠ¼Ò¸¸ SMT ¾ç»óÀÇ ectopic pancreas]

À§Ã¼ÇϺΠ¼Ò¸¸, ƯÈ÷ ¾à°£ Èĺ®ÂÊÀº ÃéÀå°ú ¸Å¿ì °¡±õ½À´Ï´Ù. ±×·¡¼­ÀÎÁö ÀÌ ºÎÀ§¿¡ SMT ¾ç»óÀÇ ectopic pancreas¸¦ Á¾Á¾ ¸¸³³´Ï´Ù. ÀüÁ¤ºÎ ´ë¸¸ ectopic pancreas¿Í ´Þ¸® umbilicatedµÈ ¼Ò°ßÀº °ÅÀÇ ¾ø½À´Ï´Ù. Á¾Á¾ bridging fold¸¦ µ¿¹ÝÇÕ´Ï´Ù. Stomach MRI¸¦ ÂïÀ¸¸é ÃéÀå°ú signalÀÌ À¯»çÇϹǷΠ°¨º°Áø´Ü¿¡ Å©°Ô µµ¿òµÈ´Ù°í ÇÏÁö¸¸ ºñº¸ÇèÀ̶ó °Ë»ç°¡ ½±Áö ¾Ê½À´Ï´Ù. ¼ö¼úÇÏ´Â ¿¹°¡ ¸¹½À´Ï´Ù¸¸, °¨º°Áø´ÜÀÌ Àß µÇ¸é ¼ö¼úÇÏÁö ¾Ê°í Áö³¾ ¼ö ÀÖÀ¸´Ï ¾ó¸¶³ª ÁÁÀº ÀÏÀԴϱî?

¼ö¼ú(wedge resection)·Î È®ÀÎµÈ ectopic pancreas

¼ö¼ú(wedge resection)·Î È®ÀÎµÈ ectopic pancreas

¼ö¼ú(wedge resection)·Î È®ÀÎµÈ ectopic pancreas

¼ö¼ú(wedge resection)·Î È®ÀÎµÈ ectopic pancreas. º´¼Ò°¡ À۾Ƽ­ ¼ö¼úÇÏÁö ¸»°í °æ°ú°üÂû ÇÒ °ÍÀ» ±ÇÇßÀ¸³ª ȯÀÚ°¡ ¼ö¼úÀ» ¿øÇϽÉ. Ÿ ÀÇ·á±â°ü¿¡¼­ º´¼Ò°¡ Ä¿Á³´Ù°í µéÀº »óȲ¿¡¼­´Â °æ°ú°üÂûÀ» ±ÇÇÏ´õ¶óµµ °á±¹ ¼ö¼úÀ» ¼±ÅÃÇϴ ȯÀÚ°¡ ¸¹À½.

¼ö¼ú(wedge resection)·Î È®ÀÎµÈ ectopic pancreas. Àü ÀÇ·á±â°ü¿¡¼­ ¼ö¼úÀ» ±ÇÀ¯¹Þ°í ¿À½Å ºÐÀÔ´Ï´Ù. ³»½Ã°æ°ú CT ¼Ò°ß µî °í·ÁÇÏ¿© °æ°ú°üÂûÀ» ±ÇÇÏ¿´À¸³ª ȯÀÚ´Â ¼ö¼ú¹Þ±â¸¦ ¿øÇϼ̽À´Ï´Ù. ¿¹»óÇÏ¿´´ø ectopic pancreas°¡ ³ª¿Ô½À´Ï´Ù. Çѹø ¼ö¼ú À̾߱⸦ µéÀ¸¸é °æ°ú°üÂûÀ» ÃßõÇصµ ¿©°£Çؼ­´Â ¼ö¼úÀ» ÀØÁö ¸øÇÏ´Â °ÍÀÌ È¯ÀÚµé ¸¶À½ °°½À´Ï´Ù. ÃÖÁ¾ Ä¡·á¹æħ °áÁ¤ Àü Á» ´õ °í¹ÎÇϴ ŵµ°¡ ÇÊ¿äÇÕ´Ï´Ù.

À§°¢ Á÷»ó¹æ SMTÀε¥ duct opening °°Àº ±¸Á¶°¡ º¸À̸ç Á¶Á÷°Ë»ç¿¡¼­ ectopic pancreas·Î È®ÀεǾú½À´Ï´Ù.


3. CardiaÀÇ À̼Ҽº ÃéÀå

[2015-11-11. ¾Öµ¶ÀÚ Áõ·Ê ÆíÁö 11]

30´ë ³²ÀÚ ¿Ü±¹ÀÎ ³ëµ¿ÀÚÀÌ°í ±Í±¹ Àü °Ç°­°ËÁøÀ» ÇÏ´Ù°¡ cardia SMT°¡ ¹ß°ßµÇ¾î ÀǷڵǼ̽À´Ï´Ù.

º¸Åë ÀÌ Á¤µµ´Â F/UÀ» Çϸ鼭 Å©±â º¯È­¸¦ º¸´Âµ¥ Àڱ⠳ª¶ó·Î °¡¸é F/UÀÌ ¾È µÈ´ä´Ï´Ù. Àú´Â pancreatobiliary EUS¿µ¿ªÀÌ ¾Æ´Ñ gastric SMT´Â EUS-FNA¸¦ ÀÚÁÖ ÇÏÁö´Â ¾Ê°í ÀÖ½À´Ï´Ù. FNAB¿¡¼­ GIST°¡ ³ª¿Ô´Âµ¥ ÀÛ´Ù°í ¼ö¼úÀ» ÇÏÁö ¾Ê°í ÁöÄѺ¸´Â °Ç Á» ÀÌ»óÇؼ­ ÀÔ´Ï´Ù. ¾Æ¿¹ ¹ºÁö ¸ð¸£°í ÃßÁ¤ÇÏ´Â °Ô ÁÁÁö, Á¶Á÷ÇÐÀûÀ¸·Î È®ÁøµÇ¸é ÀÛ´õ¶óµµ ÇØ°áÀ» ÇØ¾ß µÈ´Ù´Â °ÍÀÌ Á¦ »ý°¢ÀÔ´Ï´Ù. ±×·¡¼­ 2cm ÀÌÇÏ¸é ±×³É F/UÀ» ÇÏ°í, 2cm ÀÌ»ó 3cmÀÌÇÏ¸é ³ªÀÌ°¡ ÀþÀ¸¸é ¼ö¼úÀû Ä¡·á¸¦ °í·ÁÇÏ°í ³ªÀÌ°¡ ¸¹À» °æ¿ì 3cm±îÁö´Â ÁöÄѺ¾´Ï´Ù. ÀþÀº »ç¶÷¿¡¼­ ¼ö¼úÀ» Àû±ØÀûÀ¸·Î °í·ÁÇÏ´Â ÀÌÀ¯´Â SMT¼ö¼úÀº wedge resectionÀ¸·Î ÃæºÐÇÏ°í À§Ç輺ÀÌ ±×·¸°Ô ³ôÁö ¾Ê±â ¶§¹®ÀÔ´Ï´Ù. ÇÏÁö¸¸ cardia SMT´Â Á» ¿¹¿Ü¶ó¼­ EUS-FNAÀ» °¡²û Çϱ⵵ ÇÕ´Ï´Ù. ÀÌ È¯ÀÚÀÇ °æ¿ì ¿Ü±¹À¸·Î ³ª°¥ ¿¹Á¤ÀÌ°í º»ÀÎÀÌ Àû±ØÀûÀ¸·Î Áø´ÜÇϱ⸦ ¿øÇÏ°í GIST°¡´É¼ºÀÌ ÀÖ´Ù¸é ¼ö¼ú±îÁö ¹Þ°í ½Í´Ù°í ÇÏ¿´½À´Ï´Ù. EUS-FNA¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù.

Á¶Á÷°Ë»ç»ó ectopic pancreas°¡ ³ª¿Í ȯÀÚ´Â happyÇÏ°Ô Àڱ⠳ª¶ó·Î °¬½À´Ï´Ù. Hollow¸¦ Àü°øÇϽô °í¼ö ¼±»ý´ÔµéÀº ±»ÀÌ EUS-FNA¸¦ ½ÃÇàÇÏÁöµµ ¾Ê°í ectopic pancreas¸¦ ¸ÂÃᫀ ¼ö ÀÖÁö ¾Ê¾ÒÀ»±î »ý°¢µµ µì´Ï´Ù. Àü ÀÚ½ÅÀÌ ¾ø¾î¾î EUS-FNA¸¦ ½ÃÇàÇÏ¿´½À´Ï´Ù.

[2015-11-11. ÀÌÁØÇà ´äÀå]

¸Å¿ì ÀûÀýÇÑ ÆÇ´ÜÀ̾ú´Ù°í »ý°¢ÇÕ´Ï´Ù. Á¦°¡ 'hollow¸¦ Àü°øÇÏ´Â °í¼ö'¿¡ ³¥ ¼ö ÀÖ´ÂÁö »ý°¢ÇØ º¾´Ï´Ù. »ç½Ç cardiaÀÇ ectopic pancreas´Â óÀ½ º¸¾Ò°Åµç¿ä. ÀüÁ¤ºÎÀÇ ÀüÇüÀû º´¼Ò¸¦ Á¦¿ÜÇÏ°í´Â º¹ÀâÇÑ °Ë»ç ¾øÀÌ ectopic pancreas¸¦ ½±°Ô Áø´ÜÇϱâ´Â ½±Áö ¾Ê½À´Ï´Ù. ÃÖ±Ù »ï¼º¼­¿ïº´¿ø ¹Îº´ÈÆ ±³¼ö ÁÖµµ·Î gastric SET¿¡ ´ëÇÑ EUS-FNA ÇÑ °á°ú°¡ ³í¹®À¸·Î ³ª¿Í ¼Ò°³ÇÕ´Ï´Ù (Lee M. Medicine (Baltimore) 2015).

[2017-6-3. ÀÌÁØÇà Ãß°¡]

2017³â 6¿ù 3ÀÏ IDEN¿¡¼­ ¼º¸ðº´¿ø Á¶À¯°æ ±³¼ö´Ô²²¼­ ºñ½ÁÇÑ Áõ·Ê¸¦ º¸¿©Áּ̽À´Ï´Ù.


4. Endoscopic treatments. ³»½Ã°æ Ä¡·á

2015³â 12¿ù Gastrointestinal Endoscopy Áö¿¡ ¾Æ»êº´¿ø ³»°ú °øÀºÁ¤ ¼±»ý´Ô²²¼­ ESD·Î Ä¡·áÇÑ complicated ectopic pancreas Áõ·Ê¸¦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Gong EJ. GIE 2015). À§ ÀüÁ¤ºÎÀÇ ectopic pancreas ¿´´Âµ¥, pancreatitis¿Í cyst formationÀÌ º´¹ßÇÏ¿´´Ù°í ÇÕ´Ï´Ù. ÇÐȸÁö¿¡ Á¢¼ÓÇÏ¸é ¸ÚÁø µ¿¿µ»óÀ» º¼ ¼ö ÀÖ½À´Ï´Ù. ¸ÚÁø Áõ·Êº¸°í ÃàÇÏÇÕ´Ï´Ù.


[2013-7-7. ¾Öµ¶ÀÚ(H´ë ±³¼ö)ÀÇ Áõ·Ê]

ÃÖ±Ù SMT·Î ÃßÀû°üÂû(3rd layer¿¡ heterogenous hypoechoic lesion¿¡ ±âÀÎÇÏ´Â mass¿´À½)ÇÏ´Â Áß, 6°³¿ù ÈÄ ³»½Ã°æ °Ë»ç¿¡¼­ SMT Á߽ɺο¡ ±Ë¾çÀÌ ¹ß»ýÇÏ¿© malignant GIST¸¦ ¹èÁ¦Çϱâ À§ÇØ ESD¸¦ ½ÃÇàÇÏ¿´°í ectopic pancreas·Î Áø´ÜµÈ Áõ·Ê°¡ ÀÖ¾î ¸ÞÀÏÀ» µå¸³´Ï´Ù.


ù work dup


ÃßÀû°üÂû Áß ±Ë¾çÀÌ ¹ß»ýÇÏ¿© ESD ½ÃÇà

[2013-7-9. ÀÌÁØÇà ÀÇ°ß]

ÁÁÀº Áõ·Ê °¨»çÇÕ´Ï´Ù. Ectopic pancrea ESD´Â ÁÖº¯ Á¶Á÷°ú adhesionÀÌ ½ÉÇØ ½Ã¼úÀÌ ¾î·Á¿î °ÍÀ¸·Î ¼Ò¹®ÀÌ ÀÚÀÚÇѵ¥, º» Áõ·Ê¿¡¼­´Â ±ò²ûÇÏ°Ô Àß µÈ °Í °°½À´Ï´Ù. ¼ö°í ¸¹À¸¼Ì½À´Ï´Ù. ÁÁÀº Áõ·Ê °øÀ¯ÇØ Áּż­ °¨»çÇÕ´Ï´Ù.


5. Small bowel ectopic pancreas. ¼ÒÀå À̼Ҽº ÃéÀå

°ÇÁø³»½Ã°æ¿¡¼­ ¹ß°ßµÈ ½ÊÀÌÁöÀå º´¼ÒÀÔ´Ï´Ù. Á¶Á÷°Ë»ç¿¡¼­ pancreatic tissue°¡ °üÂûµÇ¾ú½À´Ï´Ù.


¿ì¿¬È÷ ¹ß°ßµÈ ¼ÒÀå Á¾¾çÀ̾ú½À´Ï´Ù. CT Æǵ¶Àº "proximal jejunum¿¡ delayed phase¿¡¼­ Àß °üÂûµÇ´Â noduleÀÌ Àִµ¥ subepithelial tumorÀÇ °¡´É¼ºÀÌ ÀÖÀ½. Pancreas¿Í´Â dynamic enhancement patternÀÌ ´Þ¶ó GIST ¶Ç´Â NET µîÀÇ tumorous conditionÀ¸·Î ÆÇ´ÜÇÔ."À̾ú°í ¼ÒÀå³»½Ã°æ Á¶Á÷°Ë»ç´Â "focal glandulomuscular proliferation"¿´½À´Ï´Ù

ÃÖÁ¾ °á·ÐÀº ¼ÒÀåÀÇ ectopic pancreas¿´½À´Ï´Ù.


6. Role of MRI in the evaluation of ectopic pancreas. MRIÀÇ ¿ªÇÒ

À§ÀÇ ectopic pancreas´Â MRI·Î Æò°¡ÇÒ ¼ö ÀÖ½À´Ï´Ù (º¸Çè ±ÔÁ¤ÀÌ ¹®Á¦ÀÔ´Ï´Ù. °ú°Å¿¡´Â ÀÎÁ¤ºñ±Þ¿©¿´´Âµ¥ 2020³â¿¡´Â 1ȸ¿¡ ÇÑÇØ Áø´Ü ¸ñÀû MRI°¡ º¸ÇèÀÌ µÈ´Ù´Â ¼Ò¹®Àº ÀÖÀ¸³ª °ø¹®À» ¹ÞÀº °ÍÀÌ ¾ø¾î¼­ ¸Å¿ì ¾Ö¸ÅÇÕ´Ï´Ù). ³»½Ã°æ ¼Ò°ßÀÌ ectopic pancreas¿¡ ÇÕ´çÇÑ È¯ÀÚ¿¡¼­ pancreas MRI¸¦ Âï¾îº¸¸é sequence¿¡¼­ À§Á¡¸·ÇÏÁ¾¾ç°ú pancreasÀÇ signal intensity°¡ °°À¸¸é °ÅÀÇ È®½ÇÇÏ°Ô ectopic pancreasÀÓÀ» ÃßÁ¤ÇÒ ¼ö ÀÖ½À´Ï´Ù.

¿©ÀÚ 42¼¼ (2018)
CT: Gastric prepyloric antrum GC side¿¡ ¾à 2.7 cmÀÇ outer wall based lesionÀÌ ÀǽɵÊ. ÀÎÁ¢ÇÑ duodenal bulb·ÎÀÇ extensionµµ ÀÖÀ½. À§Ä¡ ¹× ¸ð¾çÀ» °í·ÁÇÏ¿´À» ¶§ GISTº¸´Ù´Â ectopic pancreasÀÇ °¡´É¼ºÀÌ ´õ °í·ÁµÇ°í ÀÌ·¯ÇÑ °æ¿ì pancreas MRI¸¦ ½ÃÇàÇϸé pancreas¿Í signal intensity¸¦ ºñ±³ÇÏ¿© GIST¿Í ectopic pancreas °£ÀÇ °¨º°ÀÌ °¡´ÉÇÔ.
MRI: Stomach CT¿¡¼­ ÁöÀûÇÑ prepyloric antrum¿¡ 2.7 cm Å©±âÀÇ ±æÂßÇÑ ¸ð½ÀÀÇ submucosal tumor·Î º¸ÀÌ´Â º´º¯Àº Å©±â¿¡¼­ º¯È­°¡ ¾ø´Â ¸ð½ÀÀÓ. Á¶¿µÁõ°­ ¾ç»óÀ̳ª signal intensity°¡ pancreas¿Í °°¾Æ Áö³­ CT¿¡¼­ ¾ð±ÞÇÑ ¹Ù¿Í °°Àº ectopic pancreasÀÇ °¡´É¼ºÀÌ °¡Àå Å©°ÚÀ½.


[FAQ]

[2014-9-13. ¾Öµ¶ÀÚ Áú¹®]

¾È³çÇϽʴϱî? EndoTODAY¸¦ »ç¶ûÇÏ´Â µ¶ÀÚÀÔ´Ï´Ù. Àú´Â Ãé´ãµµ¸¦ Àü°øÇÏ°í ÀÖ½À´Ï´Ù. À§ Á¡¸·ÇÏÁ¾¾çÀº º¼·ÏÇÑ ÇüÅÂÀÔ´Ï´Ù. ±×·±µ¥ À̼Ҽº ÃéÀåÀº ¿Ö umbilicationÀÌ ÀÖÀ»±î¿ä? ã¾Æº» Àú³Î¿¡´Â ¾Æ·¡¿Í °°Àº ³»¿ëÀÌ ÀÖ¾ú½À´Ï´Ù. ¹°··¹°··ÇÑ lipomaµµ »§»§ÇÑ Â𻧠°°Àº ¸ð¾çÀε¥ ¿Ö ectopic pancreas´Â umbilicationÀÌ ÀÖÀ»±î¿ä?

The macroscopic appearance of heterotopic pancreas is a benign-appearing firm submucosal mass on a broad basis, sharply circumscribed from the surrounding tissue. The distinguishing feature of heterotopic pancreas is the central umbilication representing probably a rudimentary excretory duct (present in less than 50 % of cases).

[2014-9-14. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹®Àε¥ Àú´Â ´äÀ» ¸ð¸£°Ú½À´Ï´Ù. ÀϺΠectopic pancreas´Â ¿ÜºÐºñ ±â´ÉÀÌ ÀÖ¾î duct openingÀÌ À§Ä¡ÇÑ °¡¿îµ¥ ºÎÀ§°¡ ¿òÇ« ²¨Áø °Í ¾Æ´Ò±î ÃßÁ¤ÇÒ »ÓÀÔ´Ï´Ù. ±×·±µ¥ Ç×»ó umbilicationÀÌ ÀÖ´Â °Íµµ ¾Æ´Õ´Ï´Ù. ³»½Ã°æ Ä¡·á ȤÀº ¼ö¼ú·Î È®ÀÎÇÑ ectopic pancreas´Â ´ëºÎºÐ umbilicationÀÌ ¾ø¾ú½À´Ï´Ù (UmbilicationÀÌ ¾ø±â ¶§¹®¿¡ °¨º°Áø´ÜÀ» À§ÇÏ¿© ³»½Ã°æ Ä¡·á ȤÀº ¼ö¼úÀ» Çß´Ù°í º¸´Â °ÍÀÌ ¸Â½À´Ï´Ù).

À̼ҼºÃéÀå(ectopic pancreas = heterotopic pancreas)Àº µå¹°Áö ¾Ê½À´Ï´Ù. ´Ù¸¸ Áø´ÜÀÌ ¾î·Á¿ï »ÓÀÔ´Ï´Ù. EUS´Â specificity°¡ ¸¸Á·½º·´Áö ¸øÇÕ´Ï´Ù. EMR/ESD´Â ¾î·Æ°í ÃâÇ÷µµ ÈçÇÕ´Ï´Ù (»ç½Ç Àú´Â Çѹøµµ °æÇèÀÌ ¾ø½À´Ï´Ù). ÃÖ±Ù¿¡´Â endoscopic tunnel resectionÀ¸·Î Á¶Á÷À» È®ÀÎÇϱ⵵ ÇÕ´Ï´Ù (2014³â IDEN¿¡¼­ °í·Á´ë ¹ÚÁ¾Àç ¼±»ý´Ô²²¼­ live demonstrationÀ» Çϼ̽À´Ï´Ù). Çö½ÇÀûÀ¸·Î´Â ´ëºÎºÐ °æ°ú°üÂûÀ» ÇÏ°í, ¿µ ÂòÂòÇÏ¸é ¼ö¼ú(wedge resection)À» º¸³»°í ÀÖ½À´Ï´Ù.

°á±¹ ȯÀÚ¿Í ÀÇ»çÀÇ Ã¶Çп¡ ´Þ·ÁÀÖ½À´Ï´Ù. 100%¸¦ ¿øÇϸé ÀÏÀÌ ¾î·Á¿öÁý´Ï´Ù. ¾ÏÀÌ ¾Æ´Ï¶ó´Â °Í, malignant potentialÀ» °¡Áø GIST°¡ ¾Æ´Ï¶ó´Â °ÍÀ» 100% º¸ÀåÇØ´Þ¶ó°í ¿ä±¸Çϸé ÀÇ»çÀÇ ¼±ÅñÇÀÌ ¸Å¿ì Á¦Çѵ˴ϴÙ. ¾î¶»°Ôµç À߶󳻴 ¼ö ¹Û¿¡ ¾ø½À´Ï´Ù. ¹°·Ð ÇÕº´Áõ À§ÇèÀÌ µû¸¨´Ï´Ù. ºñ¿ëµµ ¹®Á¦°í, »îÀÇ Áúµµ ¹®Á¦ÀÔ´Ï´Ù. ¾Ö½á Ä¡·áÇÑ ÈÄ ºÒÇÊ¿äÇÑ Ä¡·á¿´´Ù´Â ³í¶õÀÌ ÀÏ ¼öµµ ÀÖ½À´Ï´Ù. °á±¹ 100% È®½ÇÇÏ°Ô ÇØ ´Þ¶ó¸é °æ°ú°üÂûÀ» ¸øÇÏ°í ÀýÁ¦¼úÀ» ÇÏ´Â ¼ö ¹Û¿¡ ¾ø°í ±×¿¡ µû¸¥ À§Ç輺Àº ȯÀÚ ¸òÀÔ´Ï´Ù. ±×·¯´Ï ¾î·Æ½À´Ï´Ù. öÇÐÀû ¹®Á¦ÀÔ´Ï´Ù.


[2016-4-25. ¾Öµ¶ÀÚ Áú¹®]

±³¼ö´Ô ?¾È³çÇϽʴϱî? ÁøÁ¤ ³»½Ã°æ °Ë»çÇÒ ¶§¸¶´Ù ¿£µµÅõµ¥ÀÌ °­ÀǸ¦ »ý°¢Çϸ鼭 Á¶½É Á¶½ÉÇÏ°í ÀÖ½À´Ï´Ù. ³»½Ã°æÀ» ¾ÈÀüÇÏ°Ô ÇÒ ¼ö ÀÖ°Ô ÇØÁּż­ °¨»çÇÕ´Ï´Ù.

¾Æ·¡ »çÁøµéÀº 30´ë ÃÊ¹Ý ³²ÀÚ °ËÁø ȯÀÚÀÔ´Ï´Ù. Congenital mucosal deformity ÀÎÁö, ectopic pancreas ÀÎÁö ¹®Àǵ帳´Ï´Ù. SMT ó·³ ºÒ·è Æ¢¾î³ª¿ÀÁö ¾Ê°í ÆíÆòÇصµ ectopic pancreas·Î º¼ ¼ö ÀÖ´ÂÁö¿ä?

±×¸®°í, ȯÀÚ°¡ ÀÌ·± À̼ҼºÃéÀåµµ ±â´ÉÀ» ÇÏ´ÂÁö Àú¿¡°Ô ¹°¾îº¸¾Ò´Âµ¥, »ç½Ç Àúµµ Àß ¸ð¸£´Â ¹®Á¦¿´½À´Ï´Ù. À̼Ҽº ÃéÀåµµ ±â´ÉÀ» ÇÏ´ÂÁö¿ä?

[2016-4-26. ÀÌÁØÇà ´äº¯]

¿¹. ±â´ÉÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. À̼Ҽº ÃéÀåµµ °¡²û ÃéÀå¿°À» ÀÏÀ¸Å°´Â °æ¿ì±îÁö ÀÖ½À´Ï´Ù. ¾Æ·¡ Áõ·Êº¸°í¸¦ º¸½Ã±â ¹Ù¶ø´Ï´Ù .

Pancreatitis of ectopic pancreatic tissue: a rare cause of gastric outlet obstruction

Acute pancreatitis occurring in gastric aberrant pancreas treated with surgery and proved by histological examination


[References]

1) Heterotopic pancreas at Pathology Outlines

2) Normal histology of pancreas

3) ¹Ì¶õ¼º À§¿° ȤÀº À̼Ҽº ÃéÀå? ¸¸¼ºÀ§¿° ³»½Ã°æÁø´Ü 006

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.