Malignant Transformation in Gastric Pancreatic Heterotopia A
Introduction
Heterotopia, defined as the presence of pancreatic tissue beyond the natural anatomic boundaries and without vascular or anatomic connection to the native pancreas, is a relatively common incidental finding at autopsy, discovered in approximately 0.6-15% of patients [1]. However, malignancy in these lesions is extremely rare. We herein report the case of adenocarcinoma arising from pancreatic heterotopia in the gastric antrum and review the current available literature to analyze trends of this rare diagnosis.

Case:
A Forty-five-year-old male presented with a six week history of early satiety, vomiting, and constipation consistent with gastric outlet obstruction. Upper gastrointestinal endoscopy revealed a submucosal mass with an unremarkable overlying mucosa within the gastric antrum causing obstruction of the gastric outlet.

The differential diagnosis included gastrointestinal stromal tumor (GIST) versus primary gastric malignancy and, as such further imaging was arranged. A helical CT scan with intravenous contrast showed the presence of a well-defined 4.3×2.7×3.4 cm enhancing mass located within the antrum that extended into the first part of the duodenum. The remainder of the abdomen, including the pancreas, was unremarkable aside from multiple mildly enlarged gastric and sub-pyloric lymph nodes (Figure 1)....

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