Heterotopic pancreatic tissue in the gastric cardia: A case report and literature review

Abstract

The heterotopic pancreas, which is usually described as an untypical presence of pancreatic tissue without any anatomic or vascular continuity with the pancreas, is relatively rare. Clinical manifestations may include bleeding, inflammation, pain and obstruction; however, in most cases it remains silent and is diagnosed during autopsy. Here, we report a case of ectopic pancreatic lesion located in the gastric cardia. The patient was a 73-year-old woman who had a history (over four months) of chronic epigastric pain accompanied by heartburn. Esophagogastroduodenoscopy revealed inflammatory changes throughout the stomach and lower esophagus, as well as a flat polypoid mass with benign features located in the gastric cardia, approx. 10 mm below the "Z" line, measuring approx. 7 mm in diameter. Endoscopic biopsy forceps were used to remove the lesion. Histological examination of the lesion revealed the presence of heterotopic pancreatic tissue in the gastric mucosa. On the basis of the presented case, we suggest that pancreatic ectopia should be a part of differential diagnosis, not only when dealing with submucosal gastric lesions, but also with those that are small, flat and/or untypically located.

Premalignant and Malignant Lesions of the Heterotopic Pancreas in the Esophagus: a Case Report and Review of the Literature

“…An extensive sampling of such tumors is always necessary to evaluate the origin in the ectopic tissue and exclude the possibility of coincidental lesions. Up to date, there have been only 14 cases of esophageal heterotopic pancreas in adults reported in the literature with equal incidence between males and females (Table II) [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Most patients suffered from dysphagia and epigastric pain, sometimes accompanied by signs of gastroesophageal reflux, nausea and rarely hematemesis.…”

“…Heterotopic pancreas can arise in any part of the gastrointestinal tract, most frequently in the stomach, duodenum or jejunum [2]. Up to now, there have been only 14 cases of heterotopic pancreas in the esophagus in adult patients documented in the literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Ectopic tissue is usually discovered incidentally or may become symptomatic b e c a u s e o f o b s t r u c t i o n caused by enlargement due to inflammation, bleeding or malignant transformation [3,6,7].…”

Clinical picture: multiple sites of ectopic pancreatic tissue

“…Previous case-reports describe singular sites of ectopic pancreatic tissue, to our knowledge this is the first reported case of a patient presenting with multiple sites of symptomatic ectopic pancreatic tissue (Carvalho et al 2014 ; Filip et al 2014 ; Macedo et al 2014 ).…”

Interventional endoscopic ultrasound for a symptomatic pseudocyst secondary to gastric heterotopic pancreas

“…CT can localize lesions with normal pancreatic tissue but cannot distinguish HP from other submucosal tumors[ 16 ]. Upper endoscopy generally reveals a broad-based, umbilicated, submucosal lesion, with superficial biopsies being non-diagnostic in the vast majority of cases[ 17 ]. EUS has been reported to be helpful in diagnosing HP; EUS-FNA in particular is especially effective for confirming a diagnosis of HP, with a reported sensitivity of 80%-100%[ 18 , 19 ].…”