A Case of a Rare Type of an Accessory Pancreas

A Case of a Rare Type of an Accessory Pancreas.

Kinziro Kubota

(Anatomy Department, Tokyo Medical & Dental University)

In the course of study of Zuckerkandl's bodies, I accidentally found a small accessory pancreas in the para-aortic tissue at the level of the branching off of the inferior mesenteric artery. Obviously there are a number of reports on the accessory pancreas. But, in most cases the anomalous body was found exclusively in the intestinal region extending from stomach to ileum and only in rare cases in the navel, liver, extradural cavity, etc. There is, however, no paper in the literature on this subject reporting an accessory pancreas found in the vicinity of the emerging point of the inferior mesenteric artery from the aorta. The original purpose of my research work was to dissect Zucker- kan dl's paraganglia and the lymphonodes located as a conglomera- tion in the same region. As these two kinds of nodulous bodies give a quite similar appearance in macroscopic preparations, it was neces- sary for me to determine their nature through microscopic observation. In every preparation, the dissected area was first sketched in situ as shown in fig. I. Then the entire nodulous bodies were numbered and picked out in order to make sections of them. In scanning the sections I happened to encounter in the body of an 11-year old boy a peculiar structure which was quite different from that of either paraganglion or lymphonode (fig. 2). In higher magnification and by careful observation it revealed some key structures of the pancreas. In fig. 3 we see a number of acini composed of cuboidal epithelial cells. These cells are arranged in a layer in the periphery of the acini. They contain abundant eosinophilic granules in the supranuclear part of the cytoplasm, which should be regarded as zymogen granules of the pancreas. Besides, in some acini a centro-acinar cell group is 194 K. Kubota

perceptible. These cells are stained rather bright as compared with the peripheral cells. Closely adjacent to the acini there are small tubes cut transversely or obliquely, which are intercalated portions of the duct system. In the center or paracentral part of the lobules we see a larger tube comparable to the initial section of the pancreatic duct. In the stroma there was no structure resembling the islet of Langerhans. Close scrutiny revealed, however, that there are a number of cells scattered in the connective tissue of the stroma. These cells were easily differentiated from the fibrocytes and the wall cells of the capillaries through their large, round nucleus. It is highly probable, that they are equivalents of the insular cells which are not aggregated to islets. The brighter staining of their nuclei as well as the cytoplasm will also accord with the above presumption. Resume: In a boy of 11 years an accessory pancreas was found at the level of the initiating point of the inferior mesenteric artery. It was 2.3 x 1.6 mm. in size and had a quite similar appearance to the lymphonodes as well as Zuckerkandl's paraganglia. Microscopic sections revealed, however, almost all characteristic features of the true pancreas. In closing I wish to express my sincere gratitude to Dr. T. Fujit a, Professor of Anatomy of the University of Tokyo, who corrected the manuscript and gave me valuable suggestions.

References (In the Japanese literature, only reports of major significanceare cited.) 1) Alesan dr i, R., Su di un caso di pancreas accesorio.Ann. Ital. Chir., 71, 1928. 2) An toy neti i, L., Pancreas accessorionella regione del cardias, Pathol. Anno, 14, 1922. 3) Beau, R. J. and Dreyer, N. B., Duplicationof pancreatic bladder and accessory pancreas in the Cat. Anat. Rec., 36, 1928. 4) Bol dy re f f, E. B., Report of an accessory pancreas on the ileum of a dog. Anat. Rec., 43, 1929. 5) Delhougne, Fr., Uber Pankreaskeimeim Magen. Arch. Klin. Chir., 129, 1924. 6) Doi, K., On the accessory pancreas. Tokyo Med. J., 3158,1939. (Japanese.) 7) F u k us i m a, K., On an accessory pancreas occured in the navel. Arch. f. Jap. Chir., 14, 1937.(Japanese.) 8) Gaetani, G.F. de, Particolaritâ istologichedi un pancreas accessorio nel cadaver di un neonato. Monit. Zool.Ital., 38, 1927. 9) Gegenbaur, C., Ein Fall von Nebenpankreas in der Magenwand.Arch. f. Anat., 1863. 10) Ha le, K., A study of the accessorypancreas. Ann. Surg., 83, 1926. A Case of a Rare Type of an Accessory Pancreas 195

11) Hecker, P. and Bic ar t, P., Sur deux cas de pancreas surnumeraire. Bull. Mem. Soc. Anat. Paris, 94, 1924. 12) He d r y, N. v., Nebenpankreas in der Gallenblasenwand. Bruns Beitr. Klin. Chir., 132, 1924. 13) Iiin t z sche, E., Uber verstreute Pankreaszellen in der Duodenalschlei mhaut. Z. mikr.-anat. Forsch., 46, 1939. 14) Kan a mor i, T., The accessory pancreas. Tokyo Med. J., 1031-1032,1898. (Japanese.) 15) K a s i w a mur a, T., A case of accessory pancreas. Tokyo Med. J., 31, 1904. (Japanese.) 16) K a tsur a d a, F., On the accessory pancreas. Tokyo Med. J., 1049, 1898. (Japanese.) 17) K a w a mur a, Ky. and T a k a or i, T., An accessory pancreas in the extradural cavity removed under diagnosis of spinal tumor. J. of Jap. Surg. Soc., 28, 1928. (Japanese.) 18) K ik ut i, T., An accessory pancreas in the wall of the stomach. Hyogo Igaku Zassi, 136, 1916. (Japanese.) 19) K i nuk a w a, Y., On the accessory pancreas. J. of Juzen Med. Soc., 28, 1923. (Japanese.) 20) Ma nn, Fr. C., An accessory pancreas jn the gall bladder of a dog. Anat. Rec., 23, 1923. 21) M a r u y a m a, K., Ein Fall von akzessorischem Pankreas in Lebergewebe des Menschen. J. of Exper. Medicine, 15, 1931. (Ref. s. Jap. J. Med. Sci., 1. Anat., 4, 1931.) 22) N a k an o, K., Report of an accessory pancreas. Tohoku Igaku Zassi, 38, 1948. (Japanese.) 23) Na r a b a y a si, Y., On the accessory pancreas. Trans. Soc. Path. Jap., 6, 1916. (Japanese.) 24) Nishio, Ts., Uber cinen Fall von gros3em Nebenpankreas. Kumamoto Med. J., 10, 1934. (Ref. s. Jap. J. Med. Sci., I. Anat., 6, 1936.) 25) On d a, M. and Ko bay a s i, T., A klinical observation of chronic stenosis in the intestine caused by the accessory pancreas. J. of Jap. Surg. Soc., 47, 1947. (la panese.) 26) Reitmann, K., Zwei Falle von akzessorischem Pankreas. Anat. Anz., 23, 1903. 27) Sob o t t a, J., Anatomie der Bauchspeicheldriise (Pankreas). Jena 1914. 28) Ss ok o low, P.A., Zur Frage Uber das Nebenpankreas. Anat. Anz., 70, 1930. 29) Su suk i, Sh., A patho-microscopic study of the accessory pancreas. Hokuetsu Igaku Zassi, 51, 1936. (Japanese.) 30) Symington, J., Note on a rare abnormality of the pancreas. J. of Anat. and Phys., 18, Part 3, 1885. 31) Tamura, Ky., Report of an accessory pancreas in the wall of tie Jejunum. Tohoku Igaku Zassi, 34, 1944. (Japanese.) 32) Te d es c hi, C., Uber akzessorisches Pankreas. Arch. Ital. Anat. Istol. pat., 2, 1931. 33) Thor e I, Ch., Histologisches Ober Nebenpankreas. Virchows Arch., 173, 1903. 34) U g e 1 1 i, L., Voluminoso pancreas accessorio nelle pareti di undiverticolo duodenale. Policlinico, Sez. Prat., 43, 1936. 35) Van de ndor f, F., Note sur un Pancreas gastrique accessoire. CR. Soc. Biol., 99, 1928. 36) Wagner, E., Akzessorisches Pankreas in der Magenwand. Arch. d. Heilk., 3, 1862. 37) Watanabe, H., Report of a small accessory pancreas in the wall of the stomach. Kumamoto Isen Zassi, 23, 1917. (Japanese.) 196 K. Kubota

38) Weissbers, H., Zur Entstehung der akzes3orischen Pankreas, Arch. Pathol. Anal Physiol., 281, 1931. 39) Y ama g i w a, K., Report of an accessory pancreas. Tokyo Med. J., 9, 1895. (Japanese.) 40) Zenker, F. A., Nebenpankreas in der Darmwand. Virchows Arch., 21, 1861. Plate 1

Superior . mesentenc ganglion

Fig. 2. General aspect of the accessory pancreas. Fixed in formol-bichromate, paraffin section stained with H-E, 60 x .

Accessory pancreas

Inferior mesenteric artery

Fig. 1. Paraaortic nodulous bodies sketched in 3 x and reproduced in 1.5 x magnification of the natural size. Boy of 11 years.

Intercalated duct

Bright cells Duct

Centro-acinar Blood capillary cells

Acini Fig. 3. Higher magnification of fig . 2. 500 x .