Introduction: The detection of pelvic mass with associated raised CA 125 level is highly suspicious for ovarian cancer, but there are various other benign pelvic pathologies that mimic the above fi ndings, especially in premenopausal women in the Indian subcontinent as seen in our case series. Purpose: Purpose of the study was to look for different benign pelvic masses associated with raised level of CA 125. Materials and Methods: It was prospective study in which cases of pelvic mass with raised CA 125 level that turned out to be benign in etiology on complete work up were evaluated and followed up on treatment at 2 months of interval with serial measurement of CA 125. Result: Out of 15 cases of benign pelvic masses with raised CA 125 level, 10 cases were of genital tuberculosis and associated pelvic infl ammatory disease, 4 cases were of endometriotic cysts, and 1 case was of ruptured dermoid cyst of ovary. All cases showed a signifi cant reduction in CA 125 level on follow-up at 2 months. Conclusion: There are various benign pelvic masses that are associated with raised CA 125 level. Detailed clinical history and radiological investigations can be helpful in arriving at a correct diagnosis. This is more important in India subcontinent where genital tuberculosis and pelvic infl ammatory disease are common.

/pdf/benign-pelvic-masses-associated-with-raised-ca-125-level-36h4sb2yc6.pdf

Benign Pelvic Masses Associated with Raised CA 125 Level: Radiological Pathological Correlation

Background: Pancreatic tissue that has no direct or vascular connection to the main body of the pancreas constitutes ectopic pancreas or heterotopic pancreas (HP). Majority are located in the upper gastrointestinal tract (GIT). HP may be mistaken for neoplasms like neuroendocrine tumour (NET) and adenocarcinoma on endoscopy as well as on histopathology. We report six cases of HP along with review of literature; three of them were misdiagnosed as NET. To the best of our knowledge, this is the first case series of HP from India, rest being case reports.
Materials and Methods: Histopathological features of six cases of HP were analyzed. Variables examined were clinical presentation, age at diagnosis, location, histopathologic type and immunohistochemical profile.
Results: Two cases each were seen in duodenum and Meckel’s diverticulum while one case each was seen in stomach and an atretic segment of ileum, a site never reported previously. There were five males and one female with age ranging from one day to 48 years. Patients with gastric and duodenal HP were symptomatic. On histopathology, four cases were intramuscular and two were submucosal. Four cases were of Type I and two cases were of type II.
Conclusion: HP should be considered in the differential diagnosis of submucosal upper GI lesions. Awareness, high degree of suspicion and thorough histopathological examination are necessary to arrive at a correct diagnosis. Immunohistochemistry for chromogranin and synaptophysin is useful for confirming the islets especially on small endoscopic biopsies.
Key messages: HP must be considered in the differential diagnosis of submucosal upper GI lesions. Knowledge about this entity, high degree of suspicion and thorough histopathological examination help in arriving at a correct diagnosis and excluding mimics.


Keywords: Heterotopia, Pancreas, Stomach, Duodenum.

https://www.ijpo.co.in/journal-article-file/14526

Pancreatic heterotopia: An overview of a lesion often mimicking neuroendocrine tumour

Pancreatic glandular tissue situated outside the normal anatomical site of the human body is called heterotopic pancreas. The incidence is very low as mostly it remains asymptomatic. It is usually found in association with stomach and duodenum, but it may be found in relation with any organ and even outside the abdominal cavity. When symptomatic, it may present as pain in the abdomen, pancreatitis, gastrointestinal tract bleed, abscesses, cysts, or malignancy of the concerned organ. Gastric ectopic pancreas is diagnosed by ultrasonic endoscopy and tissue biopsy. Conservative treatment gives a temporary relief. Local wedge resection of this non-malignant lesion is the ultimate treatment of choice. In the present study, we report cases of ectopic gastric antral pancreas in two young males aging 20 and 16 years who happened to be cousins. They presented with vague symptoms of epigastric pain, nausea, vomiting, etc. One of the patients had h/o melena. The diagnosis was made by endoscopic ultrasonography and confi rmed by endoscopic biopsy. This study further supports the genetic theory of ectopic pancreas as there could be a common type of abnormal genetic signaling pathway leading to trans-commitment of non-pancreatic tissue progenitors to pancreatic lineage in both patients leading to a common type of ectopic pancreatic pathology.

/pdf/heterotopic-pancreas-in-gastric-antrum-a-report-of-two-cases-160vv96t6b.pdf

Heterotopic Pancreas in Gastric Antrum: A Report of Two Cases

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Heterotopic Pancreas in Gastric Antrum: A Report of Two Cases