Small bowel (small intestine) - Heterotopic pancreas

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Small bowel (small intestine)

Congenital anomalies

Heterotopic pancreas

Reviewer: Hanni Gulwani, M.D. (see Reviewers page)
Revised: 13 December 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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● Also called adenomyoma, myoepithelial hamartoma (although without pancreatic tissue)
● Incidence of 1-14%, affects all ages but peaks in 4-6th decade
● Most common near ampulla of Vater; also stomach, jejunum
● May cause blockage of duct, leading to infection, cystic dilation and fat necrosis
● Usually incidental finding at surgery submitted for frozen section, but carcinoma may arise from pancreatic heterotopia (Arch Pathol Lab Med 1999;123:707)

Case reports
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● 39 year old woman with duodenal polyp (Case of the Week #226)

Gross description
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● Submucosal nodule, intramural mass
● Yellow-white, lobulated, 0.2 cm to 4 cm
● May have central mucosal dimple

Micro description
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● Widely separated pancreatic acini with minimally developed ducts, well formed acini may be seen (JOP 2007;8:588, Mod Pathol 2003;16:530)
● Pancreatic heterotopia may be total, only ducts, only acinar cells (exocrine heterotopia), only islet cells (endocrine heterotopia)
● Adenomyoma: predominance of pancreatic ducts with proliferation of thick smooth muscle bundles of the muscularis around the ducts (seen in periampullary region of the duodenum)

Micro images
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Various images

With acinar cell carcinoma

With ductal adenocarcinoma

Differential diagnosis
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● Well-differentiated adenocarcinoma
● Neuroendocrine tumor from endocrine heterotopia
● Cystic change in pancreatic heterotopia from duplication

Additional references
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● Arch Pathol Lab Med 2010;134:378

End of Small bowel (small intestine) > Congenital anomalies > Heterotopic pancreas

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