A Case Report of Pancreatic Acinar Metaplasia of the Distal Esophagus Mimicking Barrett’s Esophagus: A Diagnostic Pitfall

Background: Pancreatic acinar metaplasia (PAM) is defined as the presence of islands of exocrine pancreatic glands in areas outside of the pancreas. It is most commonly detected incidentally within the upper gastrointestinal tract. Histologically, PAM typically contains lobular or nested aggregates of epithelial cells with basal nuclei and abundant cytoplasm, which is acidophilic and finely granular in the apical and middle portion and basophilic in the basal compartment, closely resembling pancreatic acinar cells. Case Presentation: We report a rare case of PAM located at the gastroesophageal junction (GEJ). Endoscopic examination revealed a lesion mimicking Barrett’s esophagus. Histopathological analysis demonstrated a focus of pancreatic acinar metaplasia comprised of acinar-like cells, located at the squamocolumnar junction of esophagus, consistent with PAM. Conclusion: PAM of the esophagus is an exceptionally rare entity that may mimic other esophageal conditions on endoscopic evaluation. Accurate diagnosis relies on histopathological assessment, which is essential for differentiating this uncommon lesion from more prevalent esophageal pathologies.