Gastric ectopic pancreas: not always an innocent bystander.

Abstract

A 38-year-old male patient presented to the emergency room due to acute epigastric pain, nausea and vomiting. Physical examination revealed tenderness in the upper abdomen. Body temperature was 37.3°C. C-reactive protein was 113 mg/L (reference range: 0-3 mg/L) and his white blood cell count was raised (15.5 x109/L; reference range: 3.5-8.8 x109/L). Renal and liver function tests and serum pancreatic amylase were normal. He was otherwise healthy and was not taking any medications. Upper gastrointestinal endoscopy showed a subepithelial lesion in the gastric antrum (Figure 1). Abdominal computed tomography scan revealed a heterogeneous 4 cm malignant-looking lesion in the gastric antrum with suspected invasion of the perigastric fat (Figure 2). Endoscopic ultrasound (EUS) confirmed the presence of a subepithelial lesion in the antrum, that had heterogeneous appearance and involved all subepithelial layers of the gastric wall (Figure 3). An EUS-led fine needle aspiration (FNA) showed inflammatory cells only. The patient recovered symptomatically and blood tests normalized within 5 days. However, on the grounds of the imaging findings, malignancy could not be excluded and distal gastrectomy was performed. Histopathology of the surgical specimen confirmed the presence of ectopic pancreas in the gastric antrum (Figure 4a) but showed no cancer. However, there was both chronic and acute inflammation with neutrophil infiltration (Figure 4b). Twelve months following surgery he was asymptomatic.