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Case of the Week #226

9 December 2011 - Case of the Week #226

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Thanks to Dr. Vladimir Zaitsev, Orenburg State Oncology Hospital, Russia, for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.

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Website news:

(1) We are looking for more Cases of the weeks. Those submitted this month will be posted quickly, since the queue is short. Email your cases to NatPernick@hotmail.com.

(2) Dr. Pernick has posted a research paper, The Laws of Complexity and Self-organization: A Framework for Understanding Neoplasia, and invites your comments to NatPernick@hotmail.com.

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Case of the Week #226

Clinical History:

A 39 year old woman had an upper GI endoscopy, which revealed a small duodenal polyp, which was totally excised.

Micro images:


What is your diagnosis?


Heterotopy of pancreatic ducts into duodenal wall


Pancreatic heterotopia is a common congenital anomaly which occurs throughout the GI tract. It is usually asymptomatic, detected incidentally or at autopsy (J Gastrointest Surg 2011;15:631), although it rarely presents with intermittent gastric outlet obstruction (Ulster Med J 2010;79:100).

Pancreatic heterotopia is defined as the presence of pancreatic glandular tissue at sites with no structural or vascular contact with the main pancreas. It usually occurs in the proximal gastrointestinal tract (Med Sci Monit 2006;12:CS49). There are four histologic types: total (all cell types), canalicular (ducts only), exocrine (acinar cells only) and endocrine (islet cells only).

Ultrastructural studies may show regressive changes in the cytoplasm of the exocrine secreting epithelia, leading to necrosis of the cells, more prominent in the basal area of the secretory epithelium. These changes are attributed to regressive damage of the organelles carrying out secretory activity (Ultrastruct Pathol 2006;30:75).

Most pancreatic heterotopias are asymptomatic and require no treatment. These lesions are difficult to diagnose preoperatively as the cause of GI symptoms. Symptomatic lesions should be excised.

Nat Pernick, M.D., President
and Liz Parker, B.A., Associated Medical Editor
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com