Heterotopic pancreas (HP) is a focus of well developed, normally organized pancreatic tissue in anatomically aberrant location. HP has been detected in the duodenum, stomach, jejunum, ampulla of Vater, gallbladder, bile duct, and other sites. HP is subject to all the diseases of the pancreas proper, including malignant transformation. Benign submucosal tumors within the minor papilla are exceedingly rare and confusion with carcinoma may lead to extensive surgical resection. Endoscopic surgical techniques has expanded management options for submucosal lesions. We report our experience with the first documented case, to our knowledge, of HP in the minor papilla, as well as the first endoscopic resection of me minor papilla. A 73 y/o male with a history of epigastric pain and heartburn for several weeks, anemia and guaic positive stool was referred for endoscopy. He denied associated symptoms. PMH included DM, HTN, CAD, GERD, colon polyps, and no prior surgeries. PE revealed normal vital signs; abdomen was soft, nonlender, and without mass. Significant labs included: hematocrit 30.5%, iron 57 mcg/dl. Abd sono was normal. EGD revealed a 1.8-×1.8-cm nodular mass with central umbilication in the second portion of the duodenum. Side-view duodenoscopy showed the lesion to be located in the minor duodenal papilla; the major papilla was normal. Biopsies were nondiagnostic. ERCP revealed dominant pancreatic drainage via the ventral duct and no effacement of the dorsal duct by tumor. EUS was unavailable. The tumor was removed with snare electrocautery. Dorsal duct stenting was not performed. Pathology revealed a nodule of normal pancreatic tissue, covered by normal duodenal mucosa, c/w HP of the minor papilla. F/U duodenoscopy after one year, detected no local tumor recurrence and the patient remained asymptomatic. In summary, we described the first case of HP in the minor papilla with endoscopic resection. In the present era ERCP and EUS (where available) are essential tools in the diagnosis of major and minor papilla tumors. In a select group of high risk patients, endoscopic resection is an alternative treatment which may avoid the potential complication of open surgical resection.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging