ACCESSORY PANCREATIC TISSUE

Abstract

The occurrence of accessory pancreatic tissue in man is rather uncommon; a careful review of the literature by Warthin 1 in 1904 revealed only forty-seven cases, to which he added two.One case was reported in 1894 by Biggs,2 which was not included in Warthin's survey, since which thirty-one additional cases have been reported (Table 1).Twelve of these thirty-two cases were found at operation, the remainder at necropsy.In a series of 321 consecutive necropsies in the Mayo Clinic in which the entire length of the intestine was opened in 314 cases, I found accessory pancreases in two cases (0.6 per cent.).In one case the aberrant tissue was in the stomach; in the other, in the duodenum.These statistics conform to Opie's,3 who found ten cases of aberrant pancreatic tissue in 1,800 necropsies.In several instances, I have observed accessory pancreatic tissue in the jejunum at operation.In one instance, it was about 3 inches from the ligament of Treitz opposite the mesentery, and it was necessary to go below it in order to perform a gastro-enterostomy.A macroscopic and microscopic study of the two specimens of accessory pancreatic tissue that I found at necropsy forms the basis of this investigation.I have, in addition, reviewed the embryology of the pancreas in an effort to ascertain the cause of abnormally situated masses of pancreatic tissue. SPECIMENS OF ACCESSORY PANCREATIC TISSUECase 1 (139972).-Atnecropsy on a woman, aged 64, a small tumor was found in the duodenum, 5.5 cm.below the pylorus and 3 cm.above the papilla of the common bile duct.The base of the tumor was 1.5 cm. by 1.5 cm., and it projected 1 cm.into the lumen of the bowel (Fig. 1).Microscopic examination disclosed it to be an aberrant mass of pancreatic tissue.All the histologie structures of the pancreas were present, namely, ducts, acini, islets and con¬ nective tissue.The growth was covered by the mucous membrane of the duodenum and appeared to be embedded in the submucosa.