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Pancreas

Congenital anomalies

Heterotopic pancreas

Reviewer: Deepali Jain, M.D. (see Reviewers page)
Revised: 22 November 2012, last major update August 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

General
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● Pancreatic tissue outside boundaries of pancreas without anatomic or vascular connections to pancreas
● Also called ectopic pancreas
● Present in 0.5% to 14% of autopsies
● Due to displacement of pancreatic tissue during embryonic development
● Often in gastric antrum, duodenum, jejunum, Meckel’s diverticulum (Arch Pathol Lab Med 2003;127:E99), gastroesophageal junction (Am J Surg Pathol 1996;20:1507, Arch Pathol Lab Med 2000;124:1165)
● Usually incidental finding but may cause ulceration, obstruction, intussusception (Hum Pathol 1994;25:169)
● Vulnerable to same diseases as normal pancreas, including pancreatic endocrine tumors (2% arise in ectopic pancreatic tissue), PanIN (Am J Surg Pathol 2007;31:1191), carcinoma (Arch Pathol Lab Med 1994;118:568, Arch Pathol Lab Med 1999;123:707)

Case reports
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● 16 year old girl with pancreatic cyst in anterior mediastinum (Mod Pathol 1996;9:210)
● 42 year old woman with ductal adnocarcinoma in hetertopic tissue in rectum (Hum Pathol 2010;41:1809)

Gross description
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● 0.2 to 3 cm
● Resembles normal pancreas with firm, yellow, well-circumscribed, lobulated nodules
● May have central umbilication due to a central duct if below a mucosa (can detect radiographically)

Micro description
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● Usually in submucosa
● Almost always acinar cells and ducts; islets present in 1/3
● May be pyloric-type mucous glands
● 4 histologic types: total (all cell types), ducts only (canalicular), exocrine (acinar) only, islet cells only / endocrine (very rare, Arch Pathol Lab Med 2002;126:464)
● May have convoluted branching pattern mimicking invasive carcinoma
● Rarely retains mucus and resembles mucinous carcinoma (Am J Surg Pathol 1994;18:953)

Micro images
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Gastroesophageal junction


Jejunum


Liver: heterotopic pancreas and ductal adenocarcinoma


Meckel’s diverticulum in Crohn’s patient-figure 3

   
Stomach: purely endocrine


Stomach: heterotopic pancreas tissue in muscular layer contains ducts, acinar cells and a few islets

Differential diagnosis
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● Pancreatic metaplasia of gastric mucosa
● Endocrine subtype of heterotopia may mimic a primary or metastatic neuroendocrine tumor

Additional references
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● Am J Surg Pathol 1993;17:1134, Arch Pathol Lab Med 2003;127:e237, Am J Surg Pathol 1998;22:100

End of Pancreas > Congenital anomalies > Heterotopic pancreas

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