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LETTER TO EDITOR  
Year : 2021  |  Volume : 64  |  Issue : 5  |  Page : 178-179
Heterotopic pancreatic tissue in the gallbladder: A rare incidental finding


Department of Pathology, PGIMER and Dr. RML Hospital, New Delhi, India

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Date of Submission29-Oct-2019
Date of Decision21-Nov-2019
Date of Acceptance10-Mar-2020
Date of Web Publication7-Jun-2021
 

How to cite this article:
Gupta D, Chauhan DS, Rao S. Heterotopic pancreatic tissue in the gallbladder: A rare incidental finding. Indian J Pathol Microbiol 2021;64, Suppl S1:178-9

How to cite this URL:
Gupta D, Chauhan DS, Rao S. Heterotopic pancreatic tissue in the gallbladder: A rare incidental finding. Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Sep 22];64, Suppl S1:178-9. Available from: https://www.ijpmonline.org/text.asp?2021/64/5/178/317928




Dear Editor,

Heterotopic pancreas (HP) is an extremely rare anomaly defined by the presence of pancreatic tissue lying outside its normal location and lacking anatomical or vascular continuity with the pancreas proper.[1] In 85–90% of reported cases, HP has been noted in the stomach (24–38%), duodenum (9–36%), jejunum (0.5–27%), ileum (3–6%), and Meckel's diverticulum (2–6.5%).[2] Until the present study, less than 40 cases of HP in the gall bladder have been reported worldwide.[3] Herein, we report a case of the heterotopic pancreas of the gall bladder in a 45-year-old male presented with clinical symptoms of cholecystitis.

A 45-year-old male presented with complaints of pain in abdomen in right upper quadrant since two months,associated with nausea and vomiting off and on. All vitals were stable. Routine blood investigations including renal and liver function tests revealed no abnormality. On physical examination, there was tenderness in the right upper quadrant. On ultrasonography, multiple stones were detected in the gallbladder, the largest was 2.4 cm in diameter with features of cholecystitis. Cholecystectomy was done, and on gross examination, the gallbladder was measured 7.5 cm × 2.0 cm with the unremarkable serosal surface. No growth or polypoidal lesion was noted.

On microscopic examination, there was a well-circumscribed rest of heterotopic pancreatic tissue on the serosal aspect of the gall bladder wall, composed of lobules of exocrine pancreatic acini, and an occasional duct. Islets of Langerhans were not seen [Figure 1]a and [Figure 1]b. The diagnosis was thereby established as chronic cholecystitis with the heterotopic pancreas.
Figure 1: (a) Photomicrograph of the heterotropic pancreas in gallbladder showing surface epithelium of gallbladder (red arrow), pancreatic acini (blue arrow) (hematoxylin and eosin stain, ×100), (b) Photomicrograph of pancreatic acini with duct (H and E, ×400)

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The patient's postoperative course was uneventful and was discharged after 5 days without any complications. After a followup of 6 months, the patient was asymptomatic and had recovered fully.

The gallbladder is an extremely rare location for the heterotopic pancreas.[4] The overall incidence ranges from 0.55–13.7% in autopsies.[4] On reviewing the literature, it was found that there is a higher incidence of HP in female patients between 40 and 50 years of age.[4] However, similar to our case, its occurrences have been reported in men. In half of the reported cases, HP is preferentially localized close to the neck of the gallbladder as similar to our case.

HP in the gall bladder may exhibit several patterns, ranging from intramural to exophytic to polypoidal lesions.[5] Since there is no submucosal layer in the gall bladder, HP is usually seen in the muscularis. Microscopic examination shows a varying degree of excretory ducts, exocrine glands, and islets of Langerhans.[5]

Incidentally found ectopic pancreas has the potential to develop all of the metaplastic and neoplastic changes that occur in the normally located pancreas, including acute or chronic pancreatitis, cyst formation, calcification, pancreatic cancers, and endocrine tumors.[5] Therefore, complete excision of incidentally found pancreatic tissue is the treatment of choice. In cases of HP rests in the gallbladder, cholecystectomy is adequate.

Pancreatic heterotopia of the gallbladder is a very rare entity and its clinical significance is still undetermined. Awareness of this underreported condition may facilitate its recognition when encountered and this, in turn, may shed more light on its clinical significance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Kaur N, Chander B, Kaur H, Kaul R. Cholecystitis associated with heterotopic pancreas, pseudopyloric metaplasia, and adenomyomatous hyperplasia: A rare combination. J Lab Physicians 2016;8:126-8.  Back to cited text no. 1
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2.
Ormarsson OT, Gudmundsdottir I, Marvik R. Diagnosis and treatment of gastric heterotopic pancreas. World J Surg 2006;30:1682-9.  Back to cited text no. 2
    
3.
Sharma SP, Sohail SK, Makkawi S, Abdalla E. Heterotopic pancreatic tissue in the gallbladder. Saudi Med J 2018;39:834-7.  Back to cited text no. 3
    
4.
Lee SW, Yun SP, Seo H. Heterotopic pancreas of the gallbladder associated with segmental adenomyomatosis of the gallbladder. J Korean Surg Soc 2013;84:309-11.  Back to cited text no. 4
    
5.
Elhence P, Bansal R, Agrawal N. Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis. Int J Appl Basic Med Res 2012;2:142-3.  Back to cited text no. 5
    

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Correspondence Address:
Devender Singh Chauhan
Room No. 407, 4th Floor, PGIMER, Dr. RML Hospital, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_829_19

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