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A 46-year-old woman with upper quadrant pain and nausea, diagnosed with cholelithiasis, underwent cholecystectomy. A 0.7 cm polypoid lesion in the gallbladder showed mostly heterotopic gastric mucosa with antral and oxyntic glands and foveolar epithelium. A focal area of the heterotopic pancreas, comprising acini and ducts with positive trypsin staining but no islet cells, was found. Additional findings included minimal inflammation, an adenomyoma on the opposite wall, and black gallstones, leading to a diagnosis of a heterotopic polyp. This case underscores the importance of thorough histopathological examination in diagnosing rare heterotopic tissues in the gallbladder, preventing misdiagnosis with malignant entities.

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Ectopic pancreas, also known as heterotopic pancreas, is a rare condition in which the pancreatic tissue is found outside its usual location in the gastrointestinal (GI) tract. It is commonly asymptomatic and benign, and is often discovered incidentally during routine imaging, endoscopy, surgery, or autopsy. However, complications can arise, such as inflammation, bleeding, obstruction, or even malignant transformation, necessitating surgical intervention in some cases. Ectopic pancreas at the ampulla of Vater (EPAV) is an extremely rare condition and a diagnostic and therapeutic nightmare. Most cases have been diagnosed through invasive surgery due to concerns for malignancy, which carries significant morbidity and mortality. In our case, endoscopic snare papillectomy (ESP) was employed to establish a diagnosis. Thus far, only one other case has been reported in which ESP was used to diagnose and resect a pancreatic heterotopia at the ampulla.

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BACKGROUND: Heterotopic pancreas (HP) refers to pancreatic tissue located in areas with no vascular or anatomical connection to the pancreas. HP occurs mostly in the stomach, duodenum, and colon, and rarely in the gallbladder. CASE SUMMARY: A 57-year-old woman was referred to our hospital complaining of right upper quadrant discomfort for 3 years. An abdominal computed tomography scan revealed adenomyomatosis with a thickened fundus of the gallbladder. The patient underwent a laparoscopic cholecystectomy, and pathological examination unexpectedly showed heterotopic pancreatic tissue in the gallbladder. The patient had a favorable recovery and was discharged on postoperative day 3. She did not report any symptoms or complications at the 6-mo postoperative follow-up. Pathologists should pay close attention to such pancreatic tissue and carefully examine it for dysplasia or malignancy. CONCLUSION: This case provides more information about HP in the gallbladder, a rare occurrence.

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Perforation of Meckel's diverticulum caused by heterotopic pancreas is a rare condition. Despite recent improvements in imaging studies, Meckel"'s diverticulitis and heterotopic pancreas are difficult to diagnose preoperatively and are often diagnosed during autopsy or laparotomy. Symptomatic patients are typically >1 year, and cases of infants displaying symptoms are rarely reported. We report a rare case of heterotopic pancreas in Meckel's diverticulum causing perforation in an infant. In cases of infants presenting with unexplained acute abdominal pain, there should be a high index of suspicion for congenital gastrointestinal malformations. Prompt action in the form of exploratory laparotomy or laparoscopy is crucial to prevent the escalation of complications and to definitively confirm the diagnosis.

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Heterotopic pancreas (HP) also known as ectopic pancreas, pancreatic crest or accessory pancreas is the normal pancreatic tissue, found in a remote area other than its natural location, with no anatomic or vascular connection to main pancreatic tissue. It is a rare congenital anomaly and has been reported at many locations such as stomach (antrum) and small intestine. HP is usually an incidental finding and asymptomatic, however there are reports of pancreatitis, obstruction, perforation and malignant transformation as uncommon manifestations. Diagnosis of HP is primarily based on histological examination either by biopsy or surgical excision. Surgery is the standard treatment for symptomatic HP patients. Herein, we present a case of a 58-year-old female, who presented to us with intractable diarrhoea due to HP in the jejunum and underwent minimally invasive surgery for definitive diagnosis and treatment.

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Heterotopic pancreas is a relatively rare condition that may be associated to clinical complaints or signs. Here, we report a case of gastric heterotopic pancreas assictaed to ductal adenocarcinoma. Obstructive jaundice was the initial symptom prompting medical intervention. A 73-year-old male patient presented with yellow staining of the skin and sclera, and dull epigastric pain. Contrast-enhanced computed tomography showed stenosis of the extrahepatic distal bile duct and mass lesions of the antrum. The patient underwent tumor resection, distal gastrectomy (Billroth II), and common bile duct exploration. Postoperative pathological examination revealed an adenocarcinoma located in the wall of the gastric antrum. Immunohistochemical results suggested that the tumor originated from the pancreas. Heterologous pancreatic tissue and a dilated pancreatic duct were found in the tumor. These findings suggest malignant transformation of the gastric heterotopic pancreas. Of note, jaundice as clinical complaint for adenocarcinoma associated to gastric heterotopic pancreas.

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OBJECTIVE: Heterotopic pancreas, an uncommon condition in children, can present with diagnostic and treatment challenges. This study aimed to evaluate the clinical features and treatment options for this disorder in pediatric patients. METHODS: We conducted a retrospective analysis, including patients diagnosed with heterotopic pancreas at four tertiary hospitals between January 2000 and June 2022. Patients were categorized into symptomatic and asymptomatic groups based on clinical presentation. Clinical parameters, including age at surgery, lesion size and site, surgical or endoscopic approach, pathological findings, and outcome, were statistically analyzed. RESULTS: The study included 88 patients with heterotopic pancreas. Among them, 22 were symptomatic, and 41 were aged one year or younger. The heterotopic pancreas was commonly located in Meckel's diverticulum (46.59%), jejunum (20.45%), umbilicus (10.23%),ileum (7.95%), and stomach (6.82%). Sixty-six patients had concomitant diseases. Thirty-three patients had heterotopic pancreas located in the Meckel's diverticulum, with 80.49% of cases accompanied by gastric mucosa heterotopia (GMH). Patients without accompanying GMH had a higher prevalence of heterotopic pancreas-related symptoms (75%). Treatment modalities included removal of the lesions by open surgery, laparoscopic or laparoscopic assisted surgery, or endoscopic surgery based on patient's age, the lesion site and size, and coexisting diseases. CONCLUSIONS: Only one-fourth of the patients with heterotopic pancreas presented with symptoms. Those located in the Meckel's diverticulum have commonly accompanying GMH. Open surgical, laparoscopic surgical or endoscopic resection of the heterotopic pancreas is recommended due to potential complications. Future prospective multicenter studies are warranted to establish rational treatment options.

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INTRODUCTION AND IMPORTANCE: Obesity is a global epidemic, and bariatric surgery is an effective treatment. During this surgery, rare abnormalities in the small intestine, like ectopic pancreas (EP), can be found. CASE PRESENTATION: A 16-year-old male presented at the surgical clinic with a complaint of morbid obesity, weighing 140 KG. Since he was unable to commit to a diet, bariatric surgery was performed. During the surgery, the gastrointestinal tract was examined, and an incidental finding was noted in the wall of the proximal jejunum. The histopathology report revealed that the excisional biopsy was a complete EP in the proximal jejunum. The patient was discharged from the hospital on the first postoperative day, and his condition remained stable. CLINICAL DISCUSSION: Our case of EP stood out due to its larger size, measuring 3.5 cm in diameter, while EP lesions are typically smaller, despite its size, the patient did not experience any symptoms. EP is more commonly found in individuals between 40 and 50 years old, with a higher incidence in males. However, our patient is only 16 years old. CONCLUSION: Surgical resection is the most effective treatment, preventing malignant transformation and future complications. To the best of our knowledge, this is the first documented case of incidentally detected heterotopic pancreatic tissue in jejunum during a bariatric procedure in Syria, and it is also the fourth case in the medical literature.

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BACKGROUND: To investigate whether CT-based radiomics can effectively differentiate between heterotopic pancreas (HP) and gastrointestinal stromal tumor (GIST), and whether different resampling methods can affect the model's performance. METHODS: Multi-phase CT radiological data were retrospectively collected from 94 patients. Of these, 40 with HP and 54 with GISTs were enrolled between April 2017 and November 2021. One experienced radiologist manually delineated the volume of interest and then resampled the voxel size of the images to 0.5 × 0.5 × 0.5 mm3, 1 × 1 × 1 mm3, and 2 × 2 × 2 mm3, respectively. Radiomics features were extracted using PyRadiomics, resulting in 1218 features from each phase image. The datasets were randomly divided into training set (n = 66) and validation set (n = 28) at a 7:3 ratio. After applying multiple feature selection methods, the optimal features were screened. Radial basis kernel function-based support vector machine (RBF-SVM) was used as the classifier, and model performance was evaluated using the area under the receiver operating curve (AUC) analysis, as well as accuracy, sensitivity, and specificity. RESULTS: The combined phase model performed better than the other phase models, and the resampling method of 0.5 × 0.5 × 0.5 mm3 achieved the highest performance with an AUC of 0.953 (0.881-1), accuracy of 0.929, sensitivity of 0.938, and specificity of 0.917 in the validation set. The Delong test showed no significant difference in AUCs among the three resampling methods, with p > 0.05. CONCLUSIONS: Radiomics can effectively differentiate between HP and GISTs on CT images, and the diagnostic performance of radiomics is minimally affected by different resampling methods.

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BACKGROUND: It is critical for an accurate preoperative diagnosis of heterotopic pancreas (HP) and small gastrointestinal stromal tumor (GIST), given the unique treatment and prognosis of the two tumors. This study aims to investigate HP's computed tomography (CT) features and identify the distinguishing characteristics between HP and small GIST. METHODS: From January 2016 to August 2020, our hospital database was searched for confirmed histopathological results and CT scans for HP and GIST for further analysis. The statistically significant variables were determined by using Fisher's exact test, the Mann-Whitney U test, the receiver operating characteristic (ROC) curve and the inverse probability weighting method. RESULTS: CT images and clinical data were reviewed for 24 participants with HP and 34 patients with small GIST. Contour, border, relative enhancement grade, surface dimple, duct-like structure, short diameter (SD), attenuation of each lesion in the unenhanced phase (Lp), and the enhancement ratio of tumor in the venous phase (ER) were significant for differentiating HP from small GIST. Threshold values for SD and Lp were 1.40 cm and 42.33 Hounsfield units, respectively. Ill-defined border, surface dimple, ductlike structure, and Lp were independent factors that differentiated HP from small GIST. Additionally, SD and ER were also found to be independent factors. CONCLUSIONS: Contour, relative enhancement grade, SD, and Lp could effectively differentiate HP from small GIST, demonstrating improved diagnostic performance compared to other parameters. The presence of ductlike structures and surface dimples could further characterize HP. These findings may help distinguish HP from small GIST and avoid unnecessary invasive examination and therapy in individuals with asymptomatic HP.

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Although heterotopic pancreas usually occurs in the stomach and rarely presents as a submucosal tumor, an accurate preoperative diagnosis is often difficult because of the variety of clinical symptoms and findings depending on the size and location of the lesion. We experienced a case of gastric type III heterotopic pancreas presenting as a gastric adenomyoma in the antrum of the stomach. A 62-year-old woman visited a local hospital for epigastric discomfort. An esophagogastroduodenoscopy study indicated a submucosal tumor in the greater curvature of the gastric antrum. The patient underwent surgical resection of the tumor because it was enlarged. The histological sections of the resected specimen showed that the tumor was composed of ductular structures lined by tall columnar epithelia and a prominent smooth muscle stroma with no atypical cells. The tumor was compatible with Heinrich's type III heterotopic pancreas, which presented as an adenomyoma of the stomach. These findings provide useful histological features and some insight into a better understanding of the embryonic origin and development of adenomyoma and heterotopic pancreas in the antrum of the stomach.

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OBJECTIVE: To identify CT features and establish a nomogram, compared with a machine learning-based model for distinguishing gastrointestinal heterotopic pancreas (HP) from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS: This retrospective study included 148 patients with pathologically confirmed HP (n = 48) and GIST (n = 100) in the stomach or small intestine that were less than 3 cm in size. Clinical information and CT characteristics were collected. A nomogram on account of lasso regression and multivariate logistic regression, and a RandomForest (RF) model based on significant variables in univariate analyses were established. Receiver operating characteristic (ROC) curve, mean area under the curve (AUC), calibration curve and decision curve analysis (DCA) were carried out to evaluate and compare the diagnostic ability of models. RESULTS: The nomogram identified five CT features as independent predictors of HP diagnosis: age, location, LD/SD ratio, duct-like structure, and HU lesion/pancreas A. Five features were included in RF model and ranked according to their relevance to the differential diagnosis: LD/SD ratio, HU lesion/pancreas A, location, peritumoral hypodensity line and age. The nomogram and RF model yielded AUC of 0.951 (95% CI: 0.842-0.993) and 0.894 (95% CI: 0.766-0.966), respectively. The DeLong test found no statistically significant difference in diagnostic performance (p > 0.05), but DCA revealed that the nomogram surpassed the RF model in clinical usefulness. CONCLUSION: Two diagnostic prediction models based on a nomogram as well as RF method were reliable and easy-to-use for distinguishing between HP and GIST, which might also assist treatment planning.

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Introduction: Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception. Case Description: This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms. Discussion: Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.

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Malignant transformation of a heterotopic pancreas in the duodenum is very rare. To our knowledge, only 15 cases have been reported worldwide, including the present case. We herein report a rare case of malignant transformation of a heterotopic pancreas in the duodenum along with a review of the literature.A 65-year-old man was admitted to our hospital for evaluation of dyspepsia and vomiting. Esophagogastroduodenoscopy showed a stricture of the duodenal bulb. Laparoscopic distal gastrectomy was performed. Although a duodenal tumor had not been suspected, histopathological examination of the surgical specimen showed adenocarcinoma arising from a heterotopic pancreas (Heinrich type III) in the duodenum. Four months postoperatively, the patient received adjuvant chemotherapy. He was still alive without recurrence at 24 months of follow-up.Adenocarcinoma arising in a heterotopic pancreas is rare; therefore, preoperative diagnosis is difficult to obtain. Effective management of a heterotopic pancreas depends on the presence or absence of symptoms. Awareness of the possibility of malignant change in a heterotopic pancreas of the duodenum prior to surgery is helpful for the diagnosis and appropriate management of such patients.

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An 8-year-old male neutered Korean shorthair cat presented with chronic vomiting. Radiographically, an oval-shaped soft tissue abdominal mass caudoventral to the left kidney was detected. On ultrasonography, the hypoechoic mass was well-defined with thick, irregular, and hyperechoic margins and had no continuity with the pancreas or other adjacent organs. The mass was surgically excised. Areas of atypical pancreatic acinar epithelial cells were identified histopathologically. Postoperative CT demonstrated a normal pancreas in the expected anatomical region. Based on diagnostic imaging, surgical and histopathology findings, the mass was diagnosed as a well-differentiated pancreatic acinar cell adenocarcinoma arising from ectopic pancreatic tissue.

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Background: Meckel's diverticulum is a blind-end true diverticulum that contains all of the layers, which is normally found in the ileum. Prevalence of Meckel's diverticulum is around 2% in the general population, and even rare among adults. Gastrointestinal (GI) bleeding is a common complication of Meckel's diverticulum in children and in most cases, caused by peptic ulceration, due to ectopic gastric mucosa, while in minority cases, pancreatic tissue would also appear consisting around 6% of all Meckel's diverticulum patients. Case Description: Herein, we reported a 45-year-old man presented with recurrent hematochezia for over one-month without other remarkable symptoms or past medical history or signs on physical examination. Laboratory examinations showed hemoglobin of 114 g/L and ++++ in stool occult blood test without red blood cell. Contrasted abdominopelvic computerized tomography (CT) were normal and Meckel's electroconvulsive therapy (ECT) for identification was also negative. Considering gastroscopy and colonoscopy were both unremarkable in local hospital, double balloon enteroscopy was adopted and revealed double duct sign at about 100 cm proximal to the ileocecal valve and thus indicated existence of diverticulum. Further, ulceration was found at the far-end bottom of the blind-ending tube. The patient then underwent laparoscopic resection of Meckel's diverticulum and pathology study showed heterotopic pancreas in Meckel's diverticulum. The patient started feeding two days after surgery and was discharged on regular out-patient follow-up two weeks later. Till now, no reappear of hematochezia episode was observed. Conclusions: Heterotopic pancreas in Meckel's diverticulum is relative rare clinical condition in adult which can cause recurrent lower GI bleeding. Thus, special attention should be paid in cases with unexplained lower GI bleeding in adult.

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BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic tumor and has the potential to become malignant. Surgery is the most effective treatment at present, but there is no consensus on the site of resection. Heterotopic pancreas occurs in the gastrointestinal tract, especially the stomach and duodenum but is asymptomatic and rare. We report a case of ectopic pancreas with IPMN located in the jejunum. CASE SUMMARY: A 56-year-old male patient suffered from severe pain, nausea and vomiting due to a traffic accident and sought emergency treatment at our hospital. Contrast-enhanced computed tomography of the whole abdomen suggested splenic congestion, which was considered to be splenic rupture. Emergency laparotomy was performed, and the ruptured spleen was removed during the operation. Unexpectedly, a cauliflower-like mass of about 2.5 cm × 2.5 cm in size was incidentally found about 80 cm from the ligament of Treitz during the operation. A partial small bowel resection was performed, and postoperative pathology confirmed the small bowel mass as heterotopic pancreas with low-grade IPMN. CONCLUSION: Ectopic pancreas occurs in the jejunum and is pathologically confirmed as IPMN after surgical resection.

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INTRODUCTION AND IMPORTANCE: Heterotopic Pancreas (HP) is defined by the presence of pancreatic tissue in an anatomically distinct location from the main pancreas. While often clinically silent, it may present symptomatically. If located in the gastric antrum, HP may cause gastric outlet obstruction (GOO). The objective of this paper is to present a rare case of HP in the gastric antrum causing GOO. CASE PRESENTATION: Herein, we report a 43-year-old man who presented with abdominal pain and non-bilious emesis in the setting of COVID-19 infection and alcohol consumption. During the initial workup, computed-tomography (CT) was non-specific but demonstrated GOO, concerning for cancer. Cold forceps biopsies taken during esophagogastroduodenoscopy (EGD) confirmed benign HP. Since the patient was symptomatic from gastric outlet compression, he underwent resection via laparoscopic distal gastrectomy and Billroth II gastrojejunostomy. At 1-month postoperative follow-up, the patient recovered uneventfully. We hypothesized that GOO by HP in this case may have been associated with cumulative effects of alcohol consumption and COVID-19 infection on the ectopic tissue. CLINICAL DISCUSSION: HP is rare and difficult to diagnose preoperatively. When located in gastric antrum, HP can cause GOO, mimicking gastric malignancy. Combination of EGD/EUS, biopsy/FNA, and surgical resection are necessary to definitively make the diagnosis. Finally, it is important to consider that heterotopic pancreatitis or structural changes in HP may occur due to classic pancreatic stressors like alcohol and viral infections. CONCLUSION: HP may cause GOO presenting with non-bilious emesis and abdominal pain, mistaken for malignancy on CT imaging.

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Cystic dystrophy in heterotopic pancreas, or paraduodenal pancreatitis, is a rare and complicated presentation involving heterotopic pancreatic tissue in the duodenal wall. This condition is present in 5% of the general population but disease mainly affects middle-aged alcoholic-smoking men with chronic pancreatitis (CP). It may be purely duodenal or segmental (pancreatico-duodenopathy). Its pathophysiology arises from alcohol toxicity with obstruction of small ducts of heterotopic pancreatic tissue present in the duodenal wall and the pancreatic-duodenal sulcus, leading to repeated episodes of pancreatitis. The symptomatology includes episodes of acute pancreatitis, weight loss, and vomiting due to duodenal obstruction. Imaging shows thickening of the wall of the second portion of the duodenum with multiple small cysts. A stepwise therapeutic approach is preferred. Conservative medical treatment is favored in first intention (analgesics, continuous enteral feeding, somatostatin analogues), which allows complete symptomatic regression in 57% of cases associated with a 5% rate of complications (arterial thrombosis and diabetes). Endoscopic treatment may also be associated with conservative measures. Surgery achieves a complete regression of symptoms in 79% of cases but with a 20% rate of complications. Surgery is indicated in case of therapeutic failure or in case of doubt about a malignant tumor. Pancreaticoduodenectomy and duodenal resection with pancreatic preservation (PPDR) seem to be the most effective treatments. PPDR has also been proposed as a first-line treatment for purely duodenal location of paraduodenal pancreatitis, thereby preventing progression to an extended segmental form.

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