A 78-year-old woman was referred to our hospital complaining of
dysphagia and weight loss. Gastroscopy showed a large submucosal lesion at the
lesser curvature of the stomach ([Fig. 1]).
Computed tomography (CT) scan revealed a large tumor at the lesser curvature of
the stomach ([Fig. 2]), which was diagnosed as a
gastrointestinal stromal tumor (GIST) of the stomach. However, endoscopic
ultrasonography (EUS) showed a heterogeneous lesion with a small anechoic area
([Fig. 3]), which was suspected to be aberrant
pancreas or malignancy. The patient was successfully treated surgically by wide
excision of the lesion ([Fig. 4]). Pathological
examinations confirmed a diagnosis of aberrant pancreas ([Fig. 5]).
Fig. 1 Appearance of the
submucosal lesion with central umbilication at the body of the stomach.
a Endoscopic view, with (b)
narrow-band imaging.
Fig. 2 Computed tomography scan
revealed a large submucosal lesion at the lesser curvature of the stomach
(white arrow).
Fig. 3 A large submucosal mass
was seen at the body of the stomach by radial endoscopic ultrasound (Olympus,
Tokyo, Japan). The lesion was heterogeneous with a small anechoic area.
Fig. 4 Gross examination shows
a yellow rubbery intramural mass with ill-defined borders, measuring
3.5 × 2.5 × 1.5 cm.
Fig. 5 a Lobulated pancreatic
tissue occupies the submucosa. b The lesion contains a
mixture of pancreatic acini, ducts, and islets.
Aberrant pancreas is defined as pancreatic tissue lying outside of
its normal location and lacking anatomic or vascular connections with the
pancreas. It does not usually cause symptoms and is found incidentally in the
stomach, duodenum, small intestine, Meckel’s diverticulum
[1], or biliary tract at upper endoscopy, upper
gastrointestinal contrast radiography, laparotomy, or autopsy
[2]
[3]. Therefore, aberrant
pancreas is not a great problem in the clinical setting. Complications of
aberrant pancreas usually include inflammation with formation of an
inflammatory mass, ulceration, bleeding, and obstruction, with clinical
manifestations of acute and chronic pancreatitis [4].
Aberrant pancreas mimicking a malignant GIST of the stomach is
extremely rare, and it is difficult to obtain adequate tissue from the lesion.
The present case suggests that the finding of a large submucosal tumor of the
stomach with central umbilication and heterogeneous lesions with small anechoic
areas, as defined by endoscopy and EUS, could indicate suspected aberrant
pancreas. If the diagnosis is uncertain, the use of aggressive techniques
instead of EUS alone, including EUS-guided biopsy possibly with surgical
resection, should be advocated.
Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB
Endoscopy_UCTN_Code_CCL_1AF_2AD
