S1573 A Rare Case of Ectopic Pancreas Spotted as a Small Nodularity in Distal Esophagus

Abstract

Introduction: Heterotopic pancreatic tissue or ectopic pancreas is a congenital phenomenon in which there is presence of pancreas tissue outside of the main pancreas. The tissue is located at a separate site and is not connected to the main pancreas by means of ducts or vascular supply. We present a case of ectopic pancreatic tissue in the esophagus found on endoscopy. Case Description/Methods: A 71-year-old male with a history of gastroparesis and chronic bloating who presented to gastroenterology clinic for evaluation of flatulence. Physical exam was unremarkable and basic labs were normal. Despite a trial of low FODMAP diet and rifaximin, symptoms persisted. Hence upper endoscopy was performed and revealed salmon colored mucosal nodularity in distal esophagus which was biopsied. The gastric and duodenal mucosa appeared normal and biopsies were negative for celiac disease or Helicobacter pylori infection. The biopsy of the esophagus revealed focal pancreatic heterotopia with histological evidence of well-circumscribed small lobules of pancreatic tissue located in the submucosa underneath the esophageal squamous mucosa. There were basophilic basal granules and eosinophilic apical granules of the pancreatic acinar glands. The ectopic tissue did not contribute to any symptoms and was discovered as an incidental finding. Discussion: Ectopic pancreas can be present in various sites in the gastrointestinal tract though more frequently found in the upper tract at sites such as the stomach, duodenum and jejunum. However other sites such as the esophagus are an unusual site. It can be discovered incidentally or can have a symptomatic presentation. It can present with complications such as pancreatitis, bleeding, obstruction and may even be associated with malignant transformation in some cases. Ectopic pancreas in the esophagus is very rare and given its pre-malignant potential, gastroenterologists need to be aware and these lesions should be resected.Figure 1.: Figure A: Salmon colored mucosa noted in distal esophagus being examined under narrow band imaging. Figure B showing pancreatic heterotopia in distal esophagus on hematoxylin and eosin stain at 200X magnification. There are well-circumscribed small lobules of pancreatic tissue located in the submucosa underneath the esophageal squamous mucosa. Note the presence of basophilic basal granules and eosinophilic apical granule of the pancreatic acinar glands. A few dilated ducts are also noted.