LETTER

JOP. J Pancreas (Online) 2012 Mar 10; 13(2):243-244.

An Unusual Case of Double Heterotopic Pancreatic Tissues in the Same Localization

İsmail Hakkı Kalkan, Erkin Öztaş, Yavuz Beyazit, Burak Suvak, Hakan Yildiz, Mehmet Ibiş

Department of Gastroenterology, “Turkiye Yuksek Ihtisas” Hospital. Ankara, Turkey

Heterotopic pancreas is defined as arising of pancreatic tissue ectopically with no anatomical, neural or vascular connection to the normal pancreas [1]. We present here an unusual case that has two heterotopic pancreatic tissues in antrum.

A 31-year-old woman was admitted to our outpatient clinic with a four-month history of epigastric pain and dyspepsia. All laboratory tests of the patient were within the reference limits. She had no significant medical history and was not taking any medications. Upper gastrointestinal endoscopy revealed appearance of gastritis, and biopsies for Helicobacter pylori was taken. Also two saddle-shaped lesions in the antrum were detected. The first one of the two lesions (which was 12 mm in diameter) was located in the prepyloric antrum and the second one (which was 10 mm in diameter) was located in the proximal antrum (Figure 1). Endoscopic ultrasonography was performed in order to reveal the nature of these lesions and it revealed the diagnosis of heterotopic pancreatic tissue for both of the lesions. The first lesion in prepyloric antrum was in tubular structure, which was originating from submucosa and muscularis propria, and the second lesion was originating from submucosa. Antral biopsy revealed gastritis due to Helicobacter pylori infection and eradication therapy was performed. The heterotopic pancreatic tissues in antrum were followed up, and one year later no change in the dimensions were detected.

Figure 1. Endoscopic image of double heterotopic pancreatic tissue in antrum.

In autopsy series, it was reported that the incidence of heterotopic pancreas varies from 0.55 to 13.7%. The most common localization of heterotopic pancreas is stomach, accounting for 25-38.2% of cases. Although it is a benign condition, a few reports have described the presence of benign and malignant neoplastic changes [2, 3, 4, 5]. Although Baysoy et al. recently described a 5-year old child with double heterotopic pancreas located in various parts of the gastrointestinal tract [6], to our best knowledge our case is unique because of the occurrence of two heterotopic pancreatic tissues in the same localization. Both of the heterotopic pancreatic lesions were in the antrum in our case.

Received October 24^th, 2011 - Accepted January 19^th, 2012

Keywords Choristoma; Pancreas; Stomach

Conflicts of interest The authors have no potential conflicts of interest

Correspondence
İsmail Hakkı Kalkan
Attar Sokak 21/14
Gaziosmanpaşa/Çankaya 06700
Ankara
Turkey
Phone: +90-505.270.4085
Fax: +90-312.468.0088
E-mail: drismailster@gmail.com

References

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2. Chandan VS, Wang W. Pancreatic heterotopia in the gastric antrum. Arch Pathol Lab Med 2004; 128:111-2. (More details: [2]).

3. Huang YC, Chen HM, Jan YY, Huang TL, Chen MF. Ectopic pancreas with gastric outlet obstruction: report of two cases and literature review. Chang Gung Med J 2002; 25:485-90. (More details: [3]).

4. Reggoug I, Errabih L, Ouazzani N, Benzzoubeir H, Krami M, Raiss A, et al. Heterotopic pancreas: An unusual cause of epigastric pain. Gastroenterol Clin Biol 2010; 34(12):726-7. (More details: [4]).

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6. Baysoy G, Balamtekin N, Uslu N, Karavelioglu A, Talim B, Ozen H. Double heterotopic pancreas and Meckel's diverticulum in a child: do they have a common origin?. Turk J Pediatr 2010; 52(3):336-8. (More details: [6]).