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Non-neoplastic anomalies

Heterotopic pancreas / pancreatic acinar metaplasia

Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 28 July 2012, last major update July 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.


● Nodules of normal pancreatic tissue up to 1 cm in gastric or intestinal wall
● Prevalence 1-2% (Am J Surg Pathol 1993;17:1134)
● Incidental or presents as mass
● In 4% of pediatric gastric biopsies (Am J Surg Pathol 1998;22:100)
● Usually antrum or pylorus
● When in pylorus, localized inflammation may cause obstruction
● Strongly associated with chronic gastritis and intestinal metaplasia, but not H. pylori infection
● At GE junction in children/young adults, but may also be congenital (Arch Pathol Lab Med 2000;124:1165, Am J Surg Pathol 1996;20:1507)

Case reports

● 54 year old man with mucus retention in heterotopic pancreas of the gastric antrum simulating mucinous carcinoma (Am J Surg Pathol 1994;18:953)
● 60 year old patient With pancreatic adenocarcinoma at GE junction (Arch Pathol Lab Med 1994;118:568)

Gross description

● Nipple-like projection (with duct emptying into gastric lumen), symmetric cone or round mass
● Cut surface resembles normal pancreas, but may be cystic

Micro description

● Pancreatic acini and ducts usually present (total heterotopia), ducts often dilated, islets present in 30%
● Rarely endocrine only (case report at Arch Pathol Lab Med 2002;126:464)
● May have mucocele-like changes
● Usually in submucosa or muscularis propria

Micro images

Various images

Positive stains

● Lipase, trypsinogen, amylase

End of Stomach > Non-neoplastic anomalies > Heterotopic pancreas / pancreatic acinar metaplasia

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