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 Table of Contents  
Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 216-217

EUS of an atypical ectopic pancreas

Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA

Date of Submission24-Aug-2017
Date of Acceptance19-Oct-2017
Date of Web Publication24-Apr-2018

Correspondence Address:
Dr. Manoop S Bhutani
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1466, Houston, Texas
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_111_17

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How to cite this article:
Flores A, Papafragkakis C, Uberoi AS, Thaiudom S, Bhutani MS. EUS of an atypical ectopic pancreas. Endosc Ultrasound 2018;7:216-7

How to cite this URL:
Flores A, Papafragkakis C, Uberoi AS, Thaiudom S, Bhutani MS. EUS of an atypical ectopic pancreas. Endosc Ultrasound [serial online] 2018 [cited 2022 Dec 8];7:216-7. Available from: http://www.eusjournal.com/text.asp?2018/7/3/216/231136

A 43-year-old woman presented with abdominal pain, nausea, and vomiting. She underwent computed tomography of the abdomen and pelvis that showed a gastric subepithelial mass. Esophagogastroduodenoscopy (EGD) revealed a smooth subepithelial mass in the fundus of the stomach, 5 cm distal to the gastroesophageal junction [Figure 1]. EUS demonstrated a homogeneous, hypoechoic 14 mm × 9.7 mm lesion, originating in the gastric submucosa [Figure 2]. The pancreas had an unremarkable endosonographic appearance. EUS-FNA was performed with a 22-gauge needle. While endosonographic appearance and location were most suspicious for gastrointestinal stromal tumors (GISTs), cytology was surprisingly consistent with an ectopic pancreas (EP).
Figure 1: Smooth mass in gastric fundus

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Figure 2: EUS appearance of a hypoechoic, homogeneous mass in submucosa

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Also known as pancreatic rest, an EP refers to pancreatic tissue in the gastrointestinal tract without any anatomical or vascular continuity with the normal pancreas. The most common site of EP is the stomach (25%–38%), followed by duodenum (17%–36%) and jejunum (15%–22%).[1] The most common gastric location in over 95% of the cases is the antrum, primarily near the greater curvature.[2] Similar lesions that may confound the diagnosis are GISTs, leiomyomas, lipomas, glomus tumors, and schwannomas among others.[3] Gastric EP has been described as an elevated subepithelial nodule overlaid by a normal mucosa, with central umbilication representing the orifice of a duct, a common feature in 35%–90% of EP cases.[4],[5],[6] Definitive diagnosis of EP is made on histopathology. Being a subepithelial lesion, conventional biopsies during EGD are only diagnostic in about 10% of cases.[4] Hence, EUS-FNA provides an excellent means of obtaining adequate tissue for definitive diagnosis. EP is usually found in the submucosa, but it may also involve the deep mucosa, muscularis propria, or serosa. It is typically hypoechoic with heterogeneous echotexture. An anechoic structure consistent with a duct may be seen.[2],[5],[6]

The location of the EP in the gastric fundus in our case was very atypical. The lesion lacked central umbilication and was more suspicious for GIST or leiomyoma based on endoscopic and EUS appearance and location, with EUS-FNA surprisingly showing a classic EP.

Declaration of patient consent

The authors certify that they have obtained appropriate patient consent. The patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Christodoulidis G, Zacharoulis D, Barbanis S, et al. Heterotopic pancreas in the stomach: A case report and literature review. World J Gastroenterol 2007;13:6098-100.  Back to cited text no. 1
Attwell A, Sams S, Fukami N. Diagnosis of ectopic pancreas by endoscopic ultrasound with fine-needle aspiration. World J Gastroenterol 2015;21:2367-73.  Back to cited text no. 2
Otani Y, Yoshida M, Saikawa Y, et al. Discrimination between gastric ectopic pancreas and mesenchymal tumours, including GIST – From 12 years' surgical experience in one institute. Aliment Pharmacol Ther Symp Ser 2006;2:292-6.  Back to cited text no. 3
Agale SV, Agale VG, Zode RR, et al. Heterotopic pancreas involving stomach and duodenum. J Assoc Physicians India 2009;57:653-4.  Back to cited text no. 4
Chen SH, Huang WH, Feng CL, et al. Clinical analysis of ectopic pancreas with endoscopic ultrasonography: An experience in a medical center. J Gastrointest Surg 2008;12:877-81.  Back to cited text no. 5
Park SH, Kim GH, Park DY, et al. Endosonographic findings of gastric ectopic pancreas: A single center experience. J Gastroenterol Hepatol 2011;26:1441-6.  Back to cited text no. 6


  [Figure 1], [Figure 2]

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