Heterotopic Adipose Tissue in the Placental Parenchyma: Case Report

Objective: Reports of heterotopic tissue in the placenta are few and mainly include liver and adrenal cells. We report on adipose tissue found in the placenta. Case report: We present the case of a microscopic finding in a 25-year-old’s placenta who suffered from hypertensive disorder in pregnancy. During routine microscopic study, we observed a heterotopic, benign, circumscribed and intervillous nodule of adipose tissue. Conclusion: To our knowledge, there is no other reported case of adipocytes among chorionic villi. Why foreign tissues show up in the placenta remains unknown; however, several new theories offer explanations.

Inverted Meckel's diverticulum associated with heterotopic pancreatic tissue causing intestinal obstruction: a case report

Background Meckel’s diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It can invert or invaginate into the small intestine lumen. It is usually associated with heterotopic tissue elements. Case presentation We present a case of inverted Meckel's diverticulum, clinically and radiologically diagnosed as intestinal obstruction due to intussusceptions. The diagnosis was suspected due to target sign shown on radiological examination. Pathologically, it was inverted Meckel's diverticulum obstructing the lumen in parallel plan mimicking the telescoping appearance, with heterotopic pancreatic tissue formed of exocrine and ductal components only. Conclusions Inverted Meckel’s diverticulum may present by vague symptoms and may simulate other causes of intestinal obstruction.

Perforation of a Meckel’s diverticulum secondary to chronic NSAID use: case report and review of the literature

Meckel´s diverticulum is an abnormality in the development of the gastrointestinal system, its origin and clinical significance was first described by Johan Friedrich Meckel in 1809. It is a remnant of the omphalomesenteric duct which is usually observed following the rule of 2’s, located 2 feet proximal to the ileocecal valve, before 2 years of age in approximately 2% of the population, and is twice as common in male population. It is considered a true diverticulum because it presents all the histopathological layers of the bowel; 6% of the cases present with heterotopic tissue, mainly pancreatic, gastric, colonic or jejunal. We present the case of a 37-year-old patient who presented with acute onset epigastric pain which migrated to the right iliac fossa, he had a history of chronic non-steroidal anti-inflammatory drugs (NSAIDs) usage for articular pain. He underwent abdominal contrast tomography (CT) scan with double iodine contrast enhancement, which revealed the presence of a perforated Meckel´s diverticulum in the antimesenteric portion of the terminal ileum. The patient underwent laparoscopic diverticulectomy with no complications and was discharged 72 hours after the procedure. Histopathological confirmation of a perforated meckel’s diverticulum with heterotopic gastric mucosa confirmed the clinical suspicion of perforation secondary to chronic NSAIDs usage.

Heterotopic pancreas in the gastrointestinal tract in children: a single-center experience and a review of the literature

Background Heterotopic pancreas, that is the abnormal localization of a well-differentiated pancreatic tissue, is a rare occurrence in pediatric patients. Most lesions are found incidentally; in some circumstances, the presence of heterotopic pancreas may cause gastrointestinal symptoms, such as obstructive symptoms or bleeding. Patients and methods The clinical notes of patients with histological diagnosis of heterotopic pancreas treated at Meyer Children’s Hospital between 2009 and 2017 have been retrospectively examined. Four variables have been examined: clinical presentation, age at diagnosis, timing of surgery and localization of the heterotopic pancreas. Patients have been classified accordingly. Results Fourteen patients were diagnosed with heterotopic pancreas at a single institution. In half cases, heterotopic pancreas caused symptoms that warranted surgical exploration. Symptomatic patients were significantly older than patients in whom heterotopic pancreas was an incidental finding (mean age 9 years and 5 months vs 2 years and 9 months; p = 0.02). Heterotopic pancreas was more frequently found in patients who underwent urgent surgical procedure than in patients who underwent elective surgery (2.61% vs 0.22%; p < 0.0001). In all cases, foci of heterotopic pancreas were resected. Conclusion Heterotopic pancreas is usually discovered in the submucosa of the stomach, duodenum and small bowel. Heterotopic tissue may cause symptoms related to mechanical complications, bleeding from the surrounding intestinal mucosa or, occasionally, to the development of malignancy. Heterotopic tissue is a rare but clinically relevant cause of gastrointestinal symptoms. The presence of heterotopic tissue should be considered in children with gastrointestinal symptoms of unclear origin and surgical resection is advisable.

Vascularization of endometrial tissue in abdominal cavity – the most important link in the pathogenesis of endometriosis or its vulnerable spot in terms of treatment? (review of literature)

In this review, the stepwise mechanism of vascularization of retrogradely torn away endometrial tissue into the abdominal cavity during the formation of endometrioid heterotopy is described. The necessity of the formation of a specific microenvironment and functional rearrangement of endometrial tissue, based on the interaction of endometrial mesenchymal stem cells with peritoneal macrophages, is shown, which is the basis of adaptation to hypoxia and survival in new conditions. Attention is also paid to the similarity of tissue adaptation for endometriosis and tumor growth. The activation mechanisms for the synthesis of a number of angiogenic factors and their significance in the process of vascularization of endometrial tissue, as one of the key links in the pathogenesis of endometriosis, are highlighted. In addition, the example of the peritoneal localization of the endometriosis focus reflects the sequence of the formation of the vascular component of the communication system: an increase in vascular density in the tissue of the implantation area; vascularization of endometrioid heterotopy tissue due to angiogenesis; and the final stage of formation of the vascular network of the endometrial focus - vasculogenesis (as a mechanism for the formation of the microvasculature with the participation of circulating endothelial progenitor cells). Subsequently, the synthesis of angiogenic factors continues and actively contributes to the remodeling and increase in vascular density in the heterotopic tissue. The most important is that the increase in vascular density occurs mainly due to the immature pericyte-unprotected vessels of the microvasculature. These features constitute a fundamental basis for the diagnosis of endometriosis through the qualitative and quantitative determination of some factors in the peritoneal fluid, reflecting activation of vascularization, and for future methods of treating endometriosis by activating an angiostatic effect in the area of the pathologycal focus.

Salivary Gland Heterotopia in the Gastroesophageal Junction: A Case Series and Review of the Literature

Heterotopia is defined as the presence of mature, histologically normal, tissue in unusual anatomic sites. When this heterotopic tissue forms a mass, it is called a choristoma. This case series describes 3 cases of gastroesophageal junction (GEJ) salivary heterotopias. While heterotopias are usually incidental findings, choristomas can clinically and endoscopically mimic carcinomas and might lead to unnecessary procedures for the patients. Clinicians should therefore be aware of this entity. Literature search, however, failed to show any reports of salivary gland heterotopias in the GEJ. In fact, literature review revealed only 6 reported cases of salivary gland choristoma in the gastrointestinal tract, none at the GEJ. In this case series, we report 2 cases of salivary gland heterotopia and one case of salivary gland choristoma arising at the GE junction. To our knowledge, this is the first series of its kind in the literature.

Meckel’s diverticulum: a cadaveric case report

Meckel's diverticulum is the common congenital anamoly of the gastrointentestinal tract, caused due to failure of involution of vitelline duct after seventh or eighth week of intra-uterine life. It is usually present within the last 90cm of terminal ileum. Histologically, Meckel's diverticulum consists of all layers of small intestine. Rarely, heterotopic tissue is present derived from gastric or pancreatic tissue. In the case presented here, Meckel's diverticulum was found on the ante mesenteric border of the ileum with no peritoneal attachment during routine Anatomy cadaveric dissection. It was present 26cm proximal to the ileocecal junction, with no attachment to umbilicus. It’s blood supply was derived from the vitelline artery. Histological examination revealed the presence of 3 layers: mucosa, submucosa and muscularis propria with no heterotopic tissue.

A Mass of Pancreatic and Gastric Heterotopia Causing a Small Bowel Obstruction in a 61-Year-Old Male

Heterotopic tissue is a congenital anomaly that has been previously reported. Gastric and pancreatic heterotopia are among the most studied ones. Herein, we describe a case of a combined pancreatic and gastric heterotopia that formed a mass and caused a small intestine obstruction in a 61-year-old male. We also did a brief literature review of cases with gastric and pancreatic heterotopia in adult patients.

Adrenal heterotopic tissue in the peritoneum coincident with serous surface carcinoma

We report a case involving the concomitant presentation of two rare conditions: heterotopic adrenal tissue in the pelvic peritoneum and serous surface papillary carcinoma. A postmenopausal woman with an abdominal cystic mass and generalized ascites underwent laparotomy with the suspicion of ovarian carcinoma. Final histopathological analyses revealed serous surface carcinoma with metastasis to the endocervical canal, bilateral fallopian tubes, omentum, and para-aortic lymph nodes. Heterotopic adrenal tissue was also detected in the peritoneum. Serous surface carcinoma of the peritoneum should be considered in the differential diagnosis when ascites, omental caking, and peritoneal nodules are observed in a patient with or without an ovarian mass. Heterotopic adrenal tissue is another rare condition in adults and can be detected incidentally in the peritoneum.