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Pancreatic heterotopia presenting as a gastric submucosal lesion.

Mayes R, Mainie I, Davis R, Spence G - Ulster Med J (2010)

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Heterotopia is the normal tissue of an organ found at an abnormal site without anatomic and vascular continuity from the original organ... The usual gastrointestinal sites of Pancreatic Heterotopia (PH) include stomach, duodenum, jejunum, Meckels diverticulum, and gallbladder... Complete gastric obstruction was not evident... An upper gastrointestinal endoscopy revealed a 3cm lesion at the pylorus. (Fig 1) Ultrasound did not highlight any other cause for upper abdominal pain... Characteristic EUS features highly suggestive of PH tissue are hypoechogenicity or heteroechogenic structure... GIST also originate from the fourth layer of the GI tract and the presence of cystic spaces can indicate a risk of malignant change... The difficulty in diagnosis requires histological confirmation for a definitive answer... CT scan confirmed the endoscopic ultrasound findings... There was no eveidence of distant metastatic spread. (Fig 3) Retrospective study of CT appearances of gastric submucosal lesions shows that by using a list of specific CT criteria PH can be differentiated from small gastro intestinal stromal tumours or leiomyoma with a high degree of accuracy... The distribution of PH is 25% in the stomach and 30% in the duodenum with the rest distributed at other sites throughout the gastrointestinal tract... There is also the exceedingly rare possibility of malignant change,... This case highlights the rare aetiology of a symptomatic gastric submucosal lesion as well as the difficulty in making a preoperative diagnosis even with modern imaging modalities such as CT and EUS.

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Pancreatic exocrine glands
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fig4: Pancreatic exocrine glands

Mentions: Subsequently the patient proceeded to laparotomy where a 3cm lesion was located in the pyloric channel. A distal gastrectomy was undertaken and the patient made an uneventful recovery. Review in the outpatient department several months following surgery confirmed the relief of his symptoms. Histology revealed the lesion to be consistent with a focus of PH encompassing a cystically dilated duct. (Fig 4)


Pancreatic heterotopia presenting as a gastric submucosal lesion.

Mayes R, Mainie I, Davis R, Spence G - Ulster Med J (2010)

Pancreatic exocrine glands
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2993134&req=5

fig4: Pancreatic exocrine glands
Mentions: Subsequently the patient proceeded to laparotomy where a 3cm lesion was located in the pyloric channel. A distal gastrectomy was undertaken and the patient made an uneventful recovery. Review in the outpatient department several months following surgery confirmed the relief of his symptoms. Histology revealed the lesion to be consistent with a focus of PH encompassing a cystically dilated duct. (Fig 4)

View Article: PubMed Central - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Heterotopia is the normal tissue of an organ found at an abnormal site without anatomic and vascular continuity from the original organ... The usual gastrointestinal sites of Pancreatic Heterotopia (PH) include stomach, duodenum, jejunum, Meckels diverticulum, and gallbladder... Complete gastric obstruction was not evident... An upper gastrointestinal endoscopy revealed a 3cm lesion at the pylorus. (Fig 1) Ultrasound did not highlight any other cause for upper abdominal pain... Characteristic EUS features highly suggestive of PH tissue are hypoechogenicity or heteroechogenic structure... GIST also originate from the fourth layer of the GI tract and the presence of cystic spaces can indicate a risk of malignant change... The difficulty in diagnosis requires histological confirmation for a definitive answer... CT scan confirmed the endoscopic ultrasound findings... There was no eveidence of distant metastatic spread. (Fig 3) Retrospective study of CT appearances of gastric submucosal lesions shows that by using a list of specific CT criteria PH can be differentiated from small gastro intestinal stromal tumours or leiomyoma with a high degree of accuracy... The distribution of PH is 25% in the stomach and 30% in the duodenum with the rest distributed at other sites throughout the gastrointestinal tract... There is also the exceedingly rare possibility of malignant change,... This case highlights the rare aetiology of a symptomatic gastric submucosal lesion as well as the difficulty in making a preoperative diagnosis even with modern imaging modalities such as CT and EUS.

Show MeSH