Gastric pancreatic heterotopia: A rare disense entity

Abstract

Introduction: Heterotopic pancreas, a lesion that is rarely encountered, can be located anywhere within the gastrointestinal tract. It is commonly asymptomatic though most patients may present with pain. Its submucosal location makes preoperative diagnosis difficult. This study aims to report a small series of cases of this disease which has a very low incidence and to enumerate its clinical and endoscopic Features

Methods: From the three year archives of the histopathology department of Kathmandu Pathlab and Diagnostic Centre, all cases reported as heterotopic pancreas were collected from Jan 2013-Dec 2016. Prevalent details were extracted from the requisition forms.

Results: Out of 3,000 samples received, five cases were diagnosed as having heterotopic pancreas. The age range for the disease was 20-50 years with a male predominance. Mean diameter of the lesion was 1.6cm. The endoscopic diagnosis was heterotopic pancreas in one case whereas for others it was gastrointestinal stromal tumor (GIST). Endoscopic biopsies were non diagnostic in all cases and the diagnosis was made on local surgical resection specimen. Pain was the common presenting symptom. Microscopy showed Type I lesions in all cases with involvement of the muscularis propria in one case. Other four cases had involvement upto submucosa.

Conclusion: Though a rare entity, pancreatic heterotopias should be considered in the differential diagnosis of submucosal gastrointestinal lesion. The diagnosis of ectopic pancreas is still challenging in spite of the improvement and development in the diagnostic modalities. Symptomatic relief is provided by surgical resection and surgery is recommended particularly if diagnostic dilemma exists.