S4533 Pancreatic Heterotopia With Rare Morphology in a Rare Location: The Gastric Cardia

Introduction: Pancreatic heterotopia is an incidental finding characterized by the presence of ectopic pancreatic tissue outside its normal anatomical location. Its etiology remains unknown, although it is believed to arise from embryological developmental abnormalities. It is usually asymptomatic, but can present with heartburn, nausea, dyspepsia, diarrhea, weight loss, and gastrointestinal bleeding. Ectopic pancreatic tissue has been previously observed in the antrum, duodenum, jejunum, meckel's diverticulum, ileum, and gallbladder. Its presence in the gastric cardia is atypical, with only 1 case documented. This report describes a 78-year-old man with findings of pancreatic heterotopia in the gastric cardia, exhibiting a different macroscopic appearance from previously reported cases. Case Description/Methods: A 78-year-old man with no significant past medical history presented with a 4-month history of dyspepsia, described as “postprandial fullness and sensation of delayed gastric emptying”. He denied other associated gastrointestinal symptoms, and the physical examination was unremarkable. An esophagogastroduodenoscopy was performed for further evaluation, during which a 2 cm flat lesion, metaplastic in nature, embedded within a background of active chronic gastritis, was visualized in the gastric cardia. This lesion demonstrated an increased glandular density with foveolar architecture and opacity suggestive of metaplastic replacement and was biopsied for further workup. Histopathology revealed mild chronic gastritis, atrophic changes, and small foci of pancreatic heterotopia. No other findings were reported. Discussion: Pancreatic heterotopia is an exceptional finding that gives rise to many uncertainties. Since it can be found incidentally, accurate diagnosis is essential to avoid unnecessary interventions, emphasizing the importance of proper recognition and documentation of the lesion. In this case, the pancreatic heterotopia was found in a rare location and showed a macroscopic appearance that differed from typical descriptions in the literature. In order to determine whether pancreatic heterotopia should be included in the differential diagnosis of patients with dyspepsia or related symptoms, further long-term follow-up studies are recommended.