© Georg Thieme Verlag KG Stuttgart · New York
Heterotopic pancreas: a difficult diagnosis
19 March 2010 (online)
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.
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 . 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 . In some cases, because the findings on imaging studies are not specific for aberrant pancreas, its preoperative definitive diagnosis is difficult . 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
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G. Payeras, MD
Digestive Endoscopy Unit
Department of Gastroenterology
Sanatorio San Fco. Asis
Joaquin Costa 28 Madrid