Unusual Tissue – Unusual Issue: Pancreatic Heterotopia Presenting as Gastric Outlet Obstruction

Abstract

Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH – an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.

Gastric outlet obstruction secondary to heterotopic pancreas being mistaken for gastric cancer: “Case report”

“…Symptoms usually follow complications like gastrointestinal bleeding, obstruction including GOO, pancreatitis or malignant transformation [6] , [8] , [9] , [14] . Malignant transformation of HP is extremely rare, with a reported incidence of <1% [16] , and with the better prognosis as compared to true pancreas [17] . For a clinical purpose, it is important to keep in mind that all diseases arising in the true pancreas can also develop in heterotopic pancreatic tissue [10] .…”