Heterotopic pancreatic cyst in the adrenal gland: A case report and review of literature

Abstract

Rationale: The incidence of heterotopic pancreas (HP) is relatively rare and mainly found in the upper gastrointestinal tract, and no case of HP cyst in the adrenal gland has been reported. Informed consent has been obtained from the patient for the publication of the case details.

Patient concerns: A 21-year-old woman who presented with chronic lower back pain for a week without urinary disturbance or gastrointestinal discomfortable.

Diagnoses: Ultrasound (US) revealed a left renal cyst, and computed tomography (CT) showed a cyst in the area of the adrenal gland.

Interventions: Cystectomy was successfully performed laparoscopically. Histopathologic examination of the removed cyst wall showed heterotopic pancreatic cyst accompanied by cystic degeneration.

Outcomes: No unusual drainage or abdominal signs were observed during the 6-month follow-up.

Lessons: Despite of its rarity, HP accompanied by cyst formation in the adrenal gland area can present with waist pain. Therefore, the possibility of such disease needs to be considered. For thorough evaluation, in addition to abdominal US, CT, and/or magnetic resonance imaging, histopathological examination should sometimes be performed to make a definite diagnosis. Total excision and regular follow-up is necessary for such cases due to the potential risk of complications or recurrent cyst formation.

Figure 1

Ultrasound revealed a left renal cyst with the size of 5.1 × 4.7 cm.

Figure 2

Abdominal computed tomography scan, coronal and sagittal imaging showed the cyst (black arrows), measuring 5 × 5 cm, was located at the superomedial side of kidney closely connected with adrenal gland (white arrows) without abnormal renal morphology. No reinforcement was observed after contrast-enhanced CT scanning.

Figure 3

Histological examination of the resected specimen showed lobules of the pancreatic tissue with acini (black triangle), ducts (white arrow), islets (white triangle), and cystic area (black arrow) was coated with cuboidal epithelial tissue (H&E, ×100). H&E = hematoxylin-eosin staining.

Figure 4

Histological examination of the resected specimen showed features of abnormal pancreatic islets (black arrows) and ducts (white arrow) was adjacent to a small part of the adrenal tissue (black triangle) (H&E, ×40, ×200).

Figure 5

Ultrasound demonstrated the normal shape of adrenal gland (white arrow), kidney and pancreas. The cyst disappeared after surgery.

Figure 6

Computed tomography revealed no cystic structure in lesion area, with a relatively normal morphology of adrenal gland (white arrow) and pancreas (black arrows).