Heterotopic pancreas: a difficult diagnosis

A 45-year-old man was admitted to our hospital complaining of epigastric pain and nausea for 2 days. He had no history of systemic disease. Laboratory tests at admission, including amylase, were normal except for a 12 100/mm³ leucocyte count (89 % polymorphonuclear). Abdominal ultrasonography revealed an irregular, hypoechoic solid lesion of 37 × 28 mm, and computed tomography scan showed a 37-mm, thick-walled, extraluminal cystic lesion.

Gastroscopy revealed a submucosal lesion at the antrum of the stomach with a necrotic eschar on its surface ([Fig. 1]; [Video 1]). Endoscopic ultrasonography showed a heterogeneous lesion suggesting muscular layer necrosis. The patient was successfully treated surgically by subtotal gastrectomy. Pathological examinations confirmed a diagnosis of aberrant pancreas ([Fig. 2]).

Fig. 1 Gastroscopy revealed a submucosal lesion at the antrum of the stomach.

Video 1 Gastroscopy revealed a submucosal lesion at the antrum of the stomach with a necrotic eschar on its surface.

Fig. 2 Pathological examination confirmed a diagnosis of aberrant pancreas.

Heterotopic pancreas is the presence of pancreatic tissue lying outside of its normal location and lacking anatomic or vascular connections with the pancreas [1]. It is located in the antrum in 85 % – 95 % of cases, and it is usually asymptomatic but may become clinically evident depending on the size, location, and the pathological changes [2]. In some cases, because the findings on imaging studies are not specific for aberrant pancreas, its preoperative definitive diagnosis is difficult [3]. The definitive diagnosis of aberrant pancreas is attained on histopathological examination and it should always be considered in the differential diagnosis of gastric masses.

Competing interests: None

Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB

References

• 1 Akaraviputh T, Manuyakurn A, Lohsiriwat V. Diagnosis by endoscopic ultrasound of a large aberrant pancreas mimicking malignant gastrointestinal stromal tumor of the stomach.  Endoscopy. 2009;  41 573
• 2 Kobayashi S, Okayama Y, Hayashi K. et al . Heterotopic pancreas in the stomach which caused obstructive stenosis in the duodenum.  Intern Med. 2006;  45 1137-1141
• 3 Christodoulidis G, Zacharoulis D, Barbanis S. et al . Heterotopic pancreas in the stomach: a case report and literature review.  World J Gastroenterol. 2007;  13 6098-6100