Stomach
Other nonneoplastic
Heterotopic pancreas / pancreatic acinar metaplasia
Author: Elliot Weisenberg, M.D.
Last author update: 1 July 2012
Last staff update: 11 September 2020
Copyright: 2003-2025, PathologyOutlines.com, Inc.
PubMed Search: heterotopic pancreas
Table of Contents
Definition / general | Case reports | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stainsCite this page: Weisenberg E. Heterotopic pancreas / pancreatic acinar metaplasia. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachpancreaticheterotopia.html. Accessed April 1st, 2025.
Definition / general
- Nodules of normal pancreatic tissue up to 1 cm in gastric or intestinal wall
- Prevalence 1 - 2% (Am J Surg Pathol 1993;17:1134)
- Incidental or presents as mass
- In 4% of pediatric gastric biopsies (Am J Surg Pathol 1998;22:100)
- Usually antrum or pylorus
- When in pylorus, localized inflammation may cause obstruction
- Strongly associated with chronic gastritis and intestinal metaplasia, but not H. pylori infection
- At GE junction in children / young adults but may also be congenital (Arch Pathol Lab Med 2000;124:1165, Am J Surg Pathol 1996;20:1507)
Case reports
- 54 year old man with mucus retention in heterotopic pancreas of the gastric antrum simulating mucinous carcinoma (Am J Surg Pathol 1994;18:953)
- 60 year old patient With pancreatic adenocarcinoma at GE junction (Arch Pathol Lab Med 1994;118:568)
Gross description
- Nipple-like projection (with duct emptying into gastric lumen), symmetric cone or round mass
- Cut surface resembles normal pancreas, but may be cystic
Gross images
Contributed by Dennis J. Chute, M.D.
Heterotopic pancreas in annulus
Microscopic (histologic) description
- Pancreatic acini and ducts usually present (total heterotopia), ducts often dilated, islets present in 30%
- Rarely endocrine only (case report at Arch Pathol Lab Med 2002;126:464)
- May have mucocele-like changes
- Usually in submucosa or muscularis propria
Microscopic (histologic) images
Contributed by Dennis J. Chute, M.D.
Heterotopic exocrine pancreas in annulus
Positive stains
- Lipase, trypsinogen, amylase
