Nguyen Thu L, Kapur Shivani, Schlack-Haerer Stephen C, Gurda Grzegorz T, Folkers Milan E
Division of Medical Education, Department of Internal Medicine, Gundersen Health System, La Crosse, Wisconsin, USA.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Gundersen Health System, La Crosse, Wisconsin, USA.
Case Rep Gastroenterol. 2021 Mar 11;15(1):338-343. doi: 10.1159/000512427. eCollection 2021 Jan-Apr.
Pancreatic heterotopia (PH) is a common, but typically small (<1 cm), incidental and asymptomatic finding; however, PH should be considered even for large and symptomatic upper gastrointestinal masses. A 27-year-old white woman presented with a 3-week history of burning epigastric pain, nausea, early satiety, and constipation. Physical examination revealed epigastric and right upper quadrant tenderness with normal laboratory workup, but imaging revealed a 5-cm, partly cystic mass arising from the gastric antrum with resulting pyloric stenosis and partial gastric outlet obstruction. Endoscopic ultrasound-guided fine needle aspiration revealed PH - an anomalous pancreatic tissue lying in a nonphysiological site. The patient ultimately underwent a resection and recovered uneventfully, with a complete pathologic examination revealing normal exocrine pancreatic tissue (PH type 2) without malignant transformation. We report a case of heterotopic pancreas manifesting as severe gastric outlet obstruction, in addition to a thorough diagnostic workup and surgical follow-up, in a young adult. Differential diagnoses and features that speak to benignity of a large, symptomatic mass lesion (PH in particular) are discussed.
胰腺异位（PH）是一种常见但通常较小（<1cm）的偶然且无症状的发现；然而，即使对于较大且有症状的上消化道肿块，也应考虑胰腺异位。一名27岁的白人女性出现了3周的上腹部灼痛、恶心、早饱及便秘病史。体格检查发现上腹部和右上腹压痛，实验室检查结果正常，但影像学检查显示胃窦部有一个5cm的部分囊性肿块，导致幽门狭窄和部分胃出口梗阻。内镜超声引导下细针穿刺显示为胰腺异位——异常的胰腺组织位于非生理部位。患者最终接受了手术切除，恢复顺利，完整的病理检查显示外分泌胰腺组织正常（2型胰腺异位），无恶性转化。我们报告了一例年轻成年人胰腺异位表现为严重胃出口梗阻的病例，此外还进行了全面的诊断检查和手术随访。讨论了鉴别诊断以及提示大的、有症状的肿块病变（尤其是胰腺异位）为良性的特征。
