Chen Nelson, Gu Jessica
Department of General Surgery, The Northern Hospital, Epping, VIC, Australia.
Northern Hospital, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
Ann Hepatobiliary Pancreat Surg. 2025 May 31;29(2):205-208. doi: 10.14701/ahbps.24-190. Epub 2025 Jan 13.
Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al. HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.
异位胰腺（HP）是指在正常胰腺位置以外存在异位胰腺组织，且与胰腺无解剖或血管连续性。胆囊内异位胰腺（HPGB）于1916年由奥茨金首次描述。它仍然是一种极为罕见的病理情况，报道的病例很少。在此，我们描述一例42岁女性在因胆绞痛症状行腹腔镜胆囊切除术后发现的HPGB病例。她表现为上腹部疼痛、肝功能检查指标升高以及超声检查发现胆囊内有胆泥。她的脂肪酶和胆红素水平在正常范围内。对胆囊的组织病理学评估发现轻度慢性胆囊炎以及在胆囊胆囊管附近存在胰腺异位，具有胰腺的所有三个成分（导管、腺泡和内分泌胰岛），根据加斯帕尔·富恩特斯等人的分类符合1型。HPGB通常在胆囊切除术后的组织病理学检查中偶然被诊断出来。由于其罕见性，术前诊断具有挑战性。一般认为它是无症状的。尽管HPGB的临床意义仍不确定，但据推测HPGB可导致无结石性胆囊炎，并且也有恶变的可能性。我们的病例支持异位胰腺组织的外分泌功能可能导致胆囊慢性炎症的理论。总之，尽管HPGB是一种罕见发现且临床相关性尚不清楚，但其恶变可能性以及与胆囊炎的关联值得进一步研究。鉴于其稀缺性，关于HPGB的大多数知识来自病例报告和病例系列。本报告丰富了现有文献。
