Rare Case of Heterotopic Pancreas in the Pylorus

Heterotopic Pancreas (HP) is an aberrant anatomic malformation that occurs outside the normal anatomical site, most commonly in the upper gastrointestinal tract. Detection of HP remains a major challenge due to its similarity to submucosal tumors, so it is often misdiagnosed. For this reason, pathological confirmation is necessary to diagnose HP. A 62-year-old male patient was admitted with suspected gastric Gastrointestinal Stromal Tumor (GIST) located in the pylorus for distal resection. He reports that he first felt a palpable change under the skin of the abdominal cavity 2 years ago and since then he has been diagnosed with pancreatic and liver diseases. Scintigraphy, Computed Tomography (CT) and abdominal Magnetic Resonance (MR) imaging indicated tumor in the anterior pyloric wall. Endoscopic Ultrasound (EUS) biopsy attempt-negative. The patient was qualified for distal gastrectomy (Billroth II technique). Histopathological examination, showed a histological appearance corresponding to a HP with the presence of pancreatic ducts. The variability in presentation and difficulty with characterizing HP suggest that further observation and documentation of HP may prove beneficial in managing patients with radical resection.