Image of the Month Ectopic Pancreas in Duodenal Bulb SUN YOUNG YI Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea A 43-year-old woman underwent gastroscopy for evaluation of indigestion. A 1.5 cm, elevated, central dimpling submucosal mass was found endoscopically at the duodenal bulb (Figure A). Histologic evaluation showed small intestinal mu- cosa with marked chronic and acute inflammation as lympho- cyte infiltration and fragments of pancreatic tissue (Figure B). Ectopic pancreas is an uncommon entity and usually an incidental finding. Most patients with an ectopic pancreas are asymptomatic, and if present, symptoms are nonspecific. About 70%–75% of all pancreatic rests are located in the stomach, duodenum, and jejunum. 1–2 The most common site of duodenum is the second portion, especially reported in the periamp- ullary area. 3 The diagnosis of ectopic pancreas is easy if it shows the typical landmark of “central dimpling” as in this case. The management of ectopic pancreas depends on the presence of symptoms. If the patient is asymptomatic, as in our case, con- servative treatment with regular follow-up is recommended. This is a case of a submucosal mass with typical central dimpling in the duodenal bulb that was evaluated with endo- scopic biopsy, which led to the diagnosis of ectopic pancreas. References 1. Burduck JS, Tompson ML. Anatomy, histology, embryology, and de- velopmental anomalies of the pancreas. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Philadelphia: Saunders, 2006:1173–1187. 2. Riyas A, Cohen H. Ectopic pancreas presenting as a submucosal gastric antral tumor that was cystic on EUS. Gastrointest Endosc 2001;53:675– 677. 3. Hsu SD, Chan DC, Hsieh HF, et al. Ectopic pancreas presenting as a vater tumor. Am J Surg 2008;195:498 –500. Conflicts of interest The authors disclose no conflicts. © 2010 by the AGA Institute 1542-3565/10/$36.00 doi:10.1016/j.cgh.2009.10.005 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:e30

Ectopic Pancreas in Duodenal Bulb

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Page 1: Ectopic Pancreas in Duodenal Bulb

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mage of the Month

ctopic Pancreas in Duodenal Bulb

UN YOUNG YI

epartment of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea

Conflicts of interestThe authors disclose no conflicts.

43-year-old woman underwent gastroscopy for evaluationof indigestion. A 1.5 cm, elevated, central dimpling sub-

ucosal mass was found endoscopically at the duodenal bulbFigure A). Histologic evaluation showed small intestinal mu-osa with marked chronic and acute inflammation as lympho-yte infiltration and fragments of pancreatic tissue (Figure B).

Ectopic pancreas is an uncommon entity and usually anncidental finding. Most patients with an ectopic pancreas aresymptomatic, and if present, symptoms are nonspecific. About0%–75% of all pancreatic rests are located in the stomach,uodenum, and jejunum.1–2 The most common site of duode-um is the second portion, especially reported in the periamp-llary area.3 The diagnosis of ectopic pancreas is easy if it showshe typical landmark of “central dimpling” as in this case. The

anagement of ectopic pancreas depends on the presence ofymptoms. If the patient is asymptomatic, as in our case, con-ervative treatment with regular follow-up is recommended.

This is a case of a submucosal mass with typical centralimpling in the duodenal bulb that was evaluated with endo-copic biopsy, which led to the diagnosis of ectopic pancreas.

References. Burduck JS, Tompson ML. Anatomy, histology, embryology, and de-

velopmental anomalies of the pancreas. In: Feldman M, Friedman LS,Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and LiverDisease. 8th ed. Philadelphia: Saunders, 2006:1173–1187.

. Riyas A, Cohen H. Ectopic pancreas presenting as a submucosalgastric antral tumor that was cystic on EUS. Gastrointest Endosc2001;53:675–677.

. Hsu SD, Chan DC, Hsieh HF, et al. Ectopic pancreas presenting as

a vater tumor. Am J Surg 2008;195:498–500. doi:10.1016/j.cgh.2009.10.005

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2010;8:e30