Heterotopic Pancreatic Tissue in the Stomach—Gastroscopic Features

Abstract

Heterotopic pancreatic tissue in the gastrointestinal tract is frequently asso­ ciated with unclassifiable but definite symptoms, and the many reports of its occurrence in recent years attest to the fact that it must no longer be considered a rarity. Pearson,25 in 1951, collected 586 cases from the literature, and added 3 of his own for a total of 589. In this group, all complications of the pancreas itself were represented, including pancreatitis, islet cell tumor, cysts and non­ secreting neoplasm. The percentages given as to its usual location were: 30 per cent in the duodenum, 25 per cent in the stomach, 15 per cent in the jejunum, 3 per cent in the ileum and 6 per cent in Meckel's diverticulum. Several theories have been propounded as to the embryologic origin of heterotopic pancreas which will not be detailed here, but there is general agreement that it is congenital and is not the result of inflammation or other influences. The lesions vary in size from a few millimeters to 4 or 5 cm. in diameter, and histologically may present all the elements of normal pancreas, with acini, islet cells and ducts, although all but one of these features may be missing. Symptoms in the group as a whole are as varied as the pathologic features and locations might lead one to suspect, and numerous operations have been performed for a variety of clinical diagnoses with the eventual finding of heterotopic pancreatic tissue. Diagnosis is extremely difficult preoperatively, and the majority of such lesions discovered during life have not been suspected prior to surgery and histologic investigation. Occurrence in the StOlnach The accessibility of those lesions occurring in the stomach, where they com­ prise one fourth of all such tumors, has unfortunately aided little in the pre­ operative diagnosis. Where the central duct could be filled with barium, roentgenologists have been able to make presumptive diagnoses,14 some of which have been proved;15 but the x-ray diagnosis has usually been that of polyp, ulcer or spasm, or it has been missed altogether.