Heterotopic pancreas, is also known as ectopic pancreas, pancreatic Choristoma, pancreatic rest, and aberrant pancreas. Ectopic Pancreas is a rare congenital anomaly defined as normal pancreatic tissue located outside its normal anatomical site without anatomical, vascular and neural continuity with the pancreas in the retroperitoneum. The overall incidence of ectopic pancreas at different locations is in decimals. Its occurrence in the gallbladder is rare and rarely reported in the literature. Ectopic pancreatic tissues are usually identified in an alive individual during cholecystectomy for gallstones, acute or chronic cholecystitis, or gallbladder polyps. They do not have a specific symptom. However, they mimic the symptoms of gallstones and acute or chronic cholecystitis. The clinical significance of this pathology is unclear. In this case, we report a 36-year-old female who was suffering from right upper quadrant pain for a year, which had the characteristics of biliary colic. She had a planned laparoscopic cholecystectomy as a day case procedure. The gallbladder specimen showed there were no stones postoperatively, and the specimen was sent for histological examination. The histology report identified an ectopic pancreatic tissue in the neck of the gallbladder near the cystic duct. The histological confirmation revealed that the ectopic pancreas was mimicking a gallbladder polyp and was producing symptoms of biliary colic. International Journal of Human and Health Sciences Vol. 10 No. 01 Jan’26 Page: 61-63

Background/Objectives: Contrast-enhanced harmonic endoscopic ultrasonography (CH-EUS) is a promising tool for differentiating gastric subepithelial tumors (SETs). However, most published studies have mainly included gastrointestinal stromal tumors (GIST) and leiomyomas in the gastrointestinal tract, not limited to gastric SETs. This study evaluated the diagnostic performance of CH-EUS in gastric SETs encountered in clinical practice. Methods: We retrospectively analyzed 68 patients who underwent CH-EUS for gastric SETs between March 2021 and July 2025 at our institution. Gastric SETs were classified into benign (n = 27: ectopic pancreas, leiomyoma, schwannoma, glomus tumor, plexiform fibromyxoma, desmoid tumor, solitary fibrous tumor, and abscess) and GIST groups (n = 41). CH-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement, were assessed. Histopathological confirmation was obtained through EUS-guided fine-needle biopsy or endoscopic/surgical resection. Results: The GIST group showed significantly higher rates of arterial enhancement (95.1% vs. 74.1%, p = 0.024), irregular vessels (51.2% vs. 22.2%, p = 0.017), and diffuse enhancement (87.8% vs. 66.7%, p = 0.035) than the benign SETs. The diagnostic performance of arterial enhancement showed a sensitivity of 95.1% and specificity of 25.9%, while irregular vessels demonstrated a sensitivity of 51.2% and specificity of 77.8%, and diffuse enhancement showed a sensitivity of 87.8% and specificity of 33.3%. When combining ≥2 CH-EUS features, the sensitivity and specificity were 92.7% and 33.3%, respectively, with an overall accuracy of 69.1%. The presence of all three features yielded a specificity of 81.5% but a lower sensitivity (46.3%). Conclusions: CH-EUS exhibited a high sensitivity but low specificity in differentiating GISTs from various benign gastric SETs when using a combination of at least two CE-EUS features, including arterial enhancement, irregular vessels, and diffuse enhancement.

Abstract Introduction Heterotopic pancreas, or ectopic pancreas, is a rare developmental anomaly defined as pancreatic tissue located outside its normal anatomical position and without ductal or vascular continuity with the orthotopic pancreas. While commonly found in the stomach, duodenum, or jejunum, its occurrence within the gallbladder is exceedingly rare and typically discovered incidentally during histopathological examination following cholecystectomy. Case Presentation We report the case of a 36-year-old female who presented with intermittent upper abdominal pain and dyspepsia. Serial imaging identified gallbladder polyps and, eventually, a solitary gallstone. Due to persistent symptoms, an elective laparoscopic cholecystectomy was performed. Intraoperatively, the gallbladder appeared macroscopically unremarkable. Histopathological evaluation revealed ectopic pancreatic tissue measuring 0.4 mm within the gallbladder wall, characterized by eosinophilic acinar structures located between the lamina propria and muscularis propria, consistent with Type II heterotopic pancreas. No dysplasia or malignancy, but associated chronic inflammation was noted. Discussion Heterotopic pancreatic tissue in the gallbladder is extremely uncommon, with only a limited number of cases reported in the literature. Its asymptomatic presentation and non-specific imaging findings often mimic common biliary pathology, rendering preoperative diagnosis difficult. While generally benign, heterotopic pancreas may cause inflammation or contribute to symptoms and, in rare cases, undergo malignant transformation. Surgical excision remains both diagnostic and therapeutic. Conclusions This case emphasizes the importance of routine histopathological assessment of cholecystectomy specimens, especially in patients with atypical symptoms or inconclusive imaging. Recognition and reporting of heterotopic pancreas in rare locations such as the gallbladder are essential to improve clinical awareness, avoid misdiagnosis, and guide appropriate management.

Subepithelial tumors (SETs) located at the gastroesophageal (GE) junction remain technically challenging in minimally invasive surgery because the convergence of the esophageal sphincter, diaphragmatic hiatus, and gastric fundus creates a confined operative field. When a tumor is fully embedded within the muscular layer, its capsular margin is often indistinguishable from the serosal surface, making precise enucleation technically demanding. To address this limitation, we adopted a fluorescence-guided technique that enables accurate intraoperative localization of the tumor through indocyanine green (ICG) injection. After induction of anesthesia, approximately 0.1–0.2 mL (0.05–0.1 mg) of ICG diluted in normal saline is injected endoscopically into the submucosal plane at the tumor site for benign SETs. During surgery, near-infrared visualization provides a distinct fluorescent margin that guides safe serosal incision and enucleation while preserving the mucosa and the anatomy of the GE junction. This technique is particularly useful for benign, well-encapsulated lesions such as leiomyoma or ectopic pancreas, where clear dissection planes can be preserved. However, it should not be used for lesions with any suspicion of gastrointestinal stromal tumor or other malignant potential, because capsular or intratumoral injection may pose a theoretical risk of tumor cell dissemination. Careful peritumoral submucosal injection that avoids capsular disruption may be cautiously considered. In selected benign tumors, ICG-guided serosal enucleation provides clear localization, facilitates complete resection, and minimizes both functional and structural complications at the GE junction.

ObjectiveTo develop a CT-based decision tree model integrating clinical and imaging features for the preoperative differentiation of gastric ectopic pancreas (GEPs) and gastrointestinal stromal tumors (GISTs) with a maximum diameter of less than 3 cm. MethodsThis retrospective study included 86 patients with pathologically confirmed GEPs (n = 26) and GISTs (n = 60), all with lesions smaller than 3 cm. Clinical information and CT features were collected. The dataset was divided into training and testing sets. A decision tree classification model was constructed using key variables selected from the training set via univariate analyses and logistic regression. The decision tree's hyperparameters were optimised using five-fold cross-validation. Diagnostic performance was evaluated on an independent test set, including plotting ROC curves to calculate AUC values, sensitivity, and specificity, alongside using calibration curves to assess goodness-of-fit. Furthermore, the SHAP method was employed to provide visual explanations for the final model's predictions.ResultsThe decision tree model identified four key variables: age (clinical factor) and three CT features: ratio of lesion-to-pancreas attenuation in the arterial phase(A2), lesion long-to-short diameter ratio (LD/SD ratio), and intralesional low attenuation (ILA). The model, based on these four features, achieved an AUC of 0.744(95% CI:0.589–0.950), with sensitivity of 76.9% and specificity of 84.6%. Concurrently, calibration analysis substantiated the model's exceptional predictive precision. The Brier score (0.0648) and the Hosmer–Lemeshow test (χ2 = 5.365, df = 8, P = 0.718) both demonstrated a high degree of agreement between the model's predicted probabilities and the actual observed values.ConclusionsThe CT-based decision tree model, integrating four clinical and CT features, provides a reliable and visualized tool for differentiating GEPs from GISTs with a maximum diameter of less than 3 cm, demonstrating strong diagnostic performance.

Abstract Introduction/Objective Ectopic pancreatic tissue is defined as the presence of pancreatic tissue outside its normal anatomic location. It arises due to abnormal embryologic development, typically during foregut rotation, and may remain asymptomatic throughout life. While occasionally found in the stomach, duodenum, or jejunum, its occurrence in the gallbladder is uncommon, with only 40 cases documented in the literature. Accurate histopathological evaluation is essential to avoid misinterpretation, particularly in distinguishing this benign entity from potential malignancy. Herein, we present a case of ectopic pancreatic tissue identified in the gallbladder of a patient who underwent cholecystectomy for acute cholecystitis. Methods/Case Report A 44-year-old obese female with no other significant medical history presented with four-week history of progressively worsening abdominal pain, intermittent nausea, and vomiting. She denied fever and bowel movement changes. Examination revealed a hemodynamically stable patient with a soft, non-distended abdomen with right upper quadrant tenderness. Laboratory investigations were within normal limits. Ultrasound demonstrated gallbladder wall thickening (6.4 mm), multiple mobile calculi, and biliary sludge, findings consistent with acute cholecystitis. The patient underwent laparoscopic cholecystectomy. Gross examination revealed a gallbladder measuring 10.5 cm in length, with calculi obstructing the ductal opening and a pale mucosal surface. A pericystic lymph node measuring 0.8 cm was also noted. On histopathologic evaluation, the structure initially presumed to be a pericystic lymph node was identified as a well-circumscribed focus of ectopic pancreatic tissue situated adjacent to the pericystic duct, measuring 0.8 × 0.5 cm. The lesion was composed exclusively of exocrine pancreatic acini, with a prominent centrally located duct. No endocrine elements were present. Based on the modified von Heinrich classification, the findings were consistent with Type 3 ectopic pancreas. A diagnosis of acute cholecystitis with incidental ectopic pancreatic tissue was established. The patient experienced an uneventful postoperative course with complete recovery. Results NA. Conclusion Pancreatic heterotopia within the gallbladder wall is an uncommon finding. In the absence of distinctive radiologic or gross morphologic features, the diagnosis of ectopic pancreatic tissue remains a histopathologic challenge, relying solely on careful microscopic evaluation. Pathologists should be familiar with this rare incidental finding, as it can mimic a tumor and lead to overdiagnosis. Any grossly suspected pericystic lymph node or nodularity on the gallbladder mucosa should be submitted for histologic examination to exclude such rare entities. Although typically benign, ectopic pancreatic tissue warrants recognition due to its potential to develop the full spectrum of changes seen in orthotopic pancreas, including acute or chronic pancreatitis, cyst formation, calcification, and pancreatic tumors. The advancing integration of artificial intelligence into diagnostic pathology will enhance the accuracy of histopathologic interpretation and support timely, precise management of such diagnostically challenging cases.

S4321 Ectopic Pancreas at the Crossroads: A Rare Case at the Gastroesophageal Junction

Jejunal ectopic pancreas with malignant transformation: A case report

S3454 Ectopic Pancreas With Pseudocyst: An Elusive Cause of Recurrent Abdominal Pain

S3465 Ectopic Pancreas in the Gastric Pylorus Complicated by Acute Pancreatitis and Intramural Pseudocyst: A Case Report

ABSTRACTMediastinal teratomas demonstrating unidirectional pancreatic differentiation are exceedingly rare. We describe a 36‐year‐old woman with progressively worsening anterior chest pain. Computed tomography demonstrated a 5.9 cm multilocular cystic mass in the anterior mediastinum, accompanied by pleural and pericardial effusions. Given the lesion's size and presumed inflammatory reaction, we performed radical excision via a hemiclamshell incision. Histopathology revealed predominantly pancreatic acinar tissue with scattered non‐pancreatic epithelial elements, prompting reclassification as a mediastinal teratoma rather than ectopic pancreas. Focal epithelial disruption was regarded as the nidus of the surrounding inflammation. The patient's postoperative course was uneventful. This report underscores the need to include teratoma in the differential diagnosis of anterior mediastinal lesions initially interpreted as ectopic pancreas and illustrates the value of the hemiclamshell approach for achieving complete, atraumatic resection when extensive local adhesions are present.

A 74-year-old man presented with intestinal obstruction. CT (computed tomography) revealed a 25-mm mass in the proximal jejunum. Double-balloon endoscopy (DBE) identified a smooth, asymmetrically localized mass with oozing and luminal stenosis covered with the mucosa of swollen villi. Small bowel radiography demonstrated jejunal obstruction. Histopathological examination of the resected specimen confirmed moderately differentiated adenocarcinoma arising from ectopic pancreatic tissue of Heinrich type I. Our case suggests that cancer arising from ectopic pancreas should be considered as a candidate diagnosis of a submucosal tumor in the jejunum.

Mimics of pancreatic neoplasms at cross-sectional imaging: Pearls for characterization and diagnostic work-up.

Jejunal Ectopic Pancreas: A Case Report and Literature Review

Arteriovenous malformations of the gastrointestinal tract (AVM) can occasionally result in gastrointestinal bleeding. Less than 5% of nonvariceal upper gastrointestinal bleeding is caused by gastrointestinal AVMs, a relatively uncommon cause of GI bleeding. Clinical symptoms that they might present include intussusception, persistent anemia, overt or obscure GI bleeding, and abdominal pain. A 41-year-old male patient presented with a 7-year history of recurrent melena. An initial enteroscopy showed spurting bleeding in the jejunum with histological examination showing AVM with ectopic pancreas. The patient underwent laparotomy with resection, anastomosis, and the construction of a new duodenojejunostomy. The patient complained of recurrent melena during three years of postoperative follow-up. The patient underwent laparotomy resection of the ileum to ascending colon, ileostomy, and splenectomy. Histological examination of the bleeding duodenal mucosa confirmed an arteriovenous malformation. The patient then underwent endoscopic hemostasis using hemoclips and was treated with coil embolization. In abdominal CT, angiographic evaluation showed no visible picture of vascular malformations. Intestinal AVMs are rare but should be considered as the differential diagnosis in patients with recurrent gastrointestinal bleeding. Endoscopic hemostasis, surgical resection, and angiographic intervention can be considered as treatments for AVM.Keywords: Arteriovenous malformation, gastrointestinal bleeding, small bowel

Small intestinal endoscopic ultrasonography (SIEUS) enables the comprehensive analysis of the origin and sonographic characteristics of protruding submucosal lesions. Current evidence is limited to case reports. We aimed to investigate the application value of SIEUS for protruding lesions of the small intestine. Clinical data of patients who underwent double-balloon enteroscopy combined with SIEUS at the Sixth Affiliated Hospital of Sun Yat-Sen University between January 2023 and December 2024 were retrospectively collected. A total of 28 patients had concurrently received a diagnosis of protruding lesions of the small intestine and pathological results during their first visit. SIEUS findings were compared with the pathological results. Patient cases included stromal tumor (n = 10), ectopic pancreas (n = 7), hemangioma (n = 5), lipoma (n = 3), neuroendocrine tumor (n = 2), and invaginated Meckel's diverticulum (n = 1). All cases were initially detected via white light endoscopy (WLE) and subsequently characterized by endoscopic ultrasonography during the first visit. Pathological specimens were obtained for all lesions through biopsy, endoscopic minimally invasive surgery, or surgery. Our results indicated 100% diagnostic agreement (28/28) between endoscopic ultrasonography and pathology findings. The combination of WLE and SIEUS provides a comprehensive assessment of protruding lesions, with WLE enabling detection and SIEUS facilitating detailed submucosal characterization.

This case report is to present the anatomical variation of ectopic pancreas and discuss about its clinical significance. While dissecting an adult cadaver specimen, an ectopic pancreas specimen was found. The ectopic pancreatic tissue was located in the left lobe of the liver and the mesentery. After HE staining and microscopic observation, it was found that the ectopic pancreatic tissue contained ducts, islets, and acini, thus it was classified as Type I according to Gaspar Fuentes' classification. We report an atypical variation of ectopic pancreas, which is located in the left lobe of the liver and the mesentery. This may be associated with certain digestive system diseases such as dyspepsia. The findings of this study can provide insights for the clinical diagnosis of digestive system diseases.

Ectopic gastric mucosa (EGM) and ectopic pancreas (EP) in the stomach is a rare congenital anomaly. No research on the coexistence of EGM and EP in the stomach has been found. However, several studies have shown canceration of EGM outside the stomach and EP. Active surgical treatment may be necessary. This paper introduces a new case of ectopic gastric mucosa and ectopic pancreas in muscularis propria and serosal layer of the stomach and which were ultimately removed by endoscopic submucosal dissection combined surgery. The patient was a 25-year-old male. Upper gastrointestinal endoscopy showed a subepithelial lesion in gastric antrum. Postoperative pathology confirmed a diagnosis of EGM and EP. Enhanced computed tomography scan and endoscopic ultrasonography showed a submucosal tumor. Then endoscopic submucosal dissection was performed, during which a lesion was observed on the anterior wall of the stomach near the pylorus. This lesion invades the muscularis propria of the stomach and the large lesions near the pylorus may lead to pyloric obstruction. Considering these situations comprehensively, the patient ultimately underwent surgical resection of gastric lesion and partial gastrectomy. After 3 months of follow-up, the patient was recovering well and no recurrence of the lesion was found so far. EGM along with EP in the stomach is a rare condition. Due to its rarity, there was a lack of sufficient data support for its treatment and prognosis. Due to the EGM and EP may become cancerous, clinical attention should be paid to it. In this study, we present a new case report of EGM along with EP in the stomach and review the existing literature to explore treatment options for it.

Objective: To investigate the clinicopathological features, diagnosis, genetic alterations, and biological behaviors of hamartomatous inverted hyperplastic polyp (HIHP) in the gastrointestinal tract. Methods: The clinical, sonographic, endoscopic and pathologic data of 10 HIHP cases diagnosed at the First Affiliated Hospital of Air Force Medical University, Xi'an, China from January 2013 to March 2024 were collected. Their clinicopathological features and histological morphology were analyzed. The cases were further divided into 3 histologic subtypes. Follow-up information was collected to analyze the relationship between histological subtype and prognosis. Results: There were 5 males and 5 females in this cohort. The age of onset was 45-68 years, with a median age of 60.5 years. The polyp-involved sites included 2 cases in gastric fundus, 6 cases in gastric body, 1 case in gastric antrum, and 1 case in duodenum. Digestive endoscopy showed mucosal protrusion lesions in all cases, except 1 case (case 10) of shallow depression on the surface, with the maximum diameter ranging 0.5-2.5 cm. Endoscopic ultrasonography showed multilocular cystic low-density shadows, with septal enhancement (case 4). The preoperative clinical diagnosis was gastric polyp, ectopic pancreas or gastrointestinal stromal tumor. Two cases showed type 1 morphology (i.e., connected with the mucosa, with clear smooth muscle boundaries). One of them (case 10) had a clear opening to form a vase-like morphology, while the other (case 4) had no obvious opening with the surface mucosa. Three cases showed type 2 morphology (i.e., not connected with the mucosa, with clear smooth muscle boundaries). Five cases showed type 3 morphology (i.e., not connected with the mucosa, without clear smooth muscle boundaries or hyperplastic smooth muscle that separated hyperplastic glands showing lobular configuration). Among them, one case of duodenal lesions (case 9) showed gastric type gland hyperplasia and expansion, including gastric fossa, gastric fundic gland and pyloric gland, with various arrangement and combination, accompanied by smooth muscle hyperplasia. In case 10, there was leiomyomatous proliferation in the stroma. The cases 2 and 4 had atypical glandular structures and cell morphology, but immunohistochemistry showed wild-type expression pattern of p53 and a Ki-67 proliferation index of less than 1%, suggesting that it was reactive atypia secondary to inflammation. The results showed that 3 cases had different gene mutations, and no recurrent gene change was identified. All patients survived without disease during the follow-up period of 1-130 months. Conclusions: HIHP is a benign lesion and has no consistently detectable genetic alterations. The histological characteristics of gastrointestinal polyps are complex. Especially, the types 1 and 3 of HIHP have unique gross and microscopic features, which require combination of proper endoscopic sampling and histological examination to correctly classify them.

Incidental Neuroendocrine Tumor in Mesocolonic Ectopic Pancreas Discovered During Colorectal Cancer Surgery