CASE REPORT Heterotopic pancreas in gastric antrum with macroscopic appearance of gastric polyp Hlavaty T, Lukac L, Vyskocil M, Galbavy S Bratisl Lek Listy 2002; 103 (3): 117-120 1st Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia, and Department of Pathology, Univer- sity Hospital, Comenius University, Bratislava, Slovakia Address for correspondence: T. Hlavaty, MD, University Hospital, Comenius University, 1st Dept of Internal Medicine, Mickiewiczova 13, SK-813 69 Bratislava 1, Slovakia. Phone: +421.2.903260230, Fax: +421.2.57290309 1st Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia.tibor_hlavaty@nextra.sk Abstract Heterotopic pancreas is a relatively rare clinical diagnosis, not commonly involved in differential diagnostic considerations of GI symptoms. The authors report a case of heterotopic pancreas disco- vered endoscopically in the gastric antrum. A 60-year-old woman presented with epigastric pain. The patient took alendronate for osteoporosis. The endoscopic examination revealed Helicobacter pylori positive antral atrophic gastropathy and a well delineated hemispherical polyp, 8 mm in diameter, in the antrum of the stomach. Histology showed antral gastritis and the presence of hete- rotopic pancreas. After dietary measures and Helicobacter eradication, the patient was relieved of symptoms. According to the authors opinion, the finding of heterotopic pancreas did not necessitate intervention, and was an incidental finding. The authors discuss the significance of heterotopic pancreas with the conclusion that the resection of the lesion is indicated only if consistent symptoms are present. (Fig. 3, Ref. 28.) Key words: heterotopic pancreas, submucosal tumour, stomach, gastroduodenoscopy. 117 Heterotopic pancreas is defined as the presence of abnor- mally located pancreatic glandular tissue with no structural or vascular continuity with the main pancreas (1). Synonymous terms such as aberrant pancreas, ectopic pancreas and pancreas accesorium seu supranumerale are used as well. As reported by Barbosa deCastro et al (2), Schultz reported the first example of heterotopic pancreas in 1727 and Klob published his first micro- scopic histological observations in 1859. Prevalence of heterotopic pancreas is estimated to be appro- ximately 2 % (3). Many or most of heterotopic pancreatic le- sions cause no clinical symptoms, and are found incidentally during endoscopic examinations, laparotomies and autopsies. However it may result in various acute or chronic gastrointesti- nal (GI) manifestations, eventually it may develop serious com- plications including upper GI bleeding, gastric ulcers or even malignant degeneration. Heterotopic pancreas is a relatively rare clinical diagnosis, not commonly involved in differential diagnostic considerations of GI symptoms. The purpose of this report is to present a case with this anomaly and provide up-to-date literature review on this topic. Case Report A 60-year-old woman was referred in July 2000 to the out- patient department of the University Hospital of Comenius Uni- versity in Bratislava for the evaluation of epigastric pain. The patient had presented to the hospital with vague complaints of epigastric pain typically worsened during fasting. Patient repor- ted also anorexia, easy fatigability and general weakness. Symp- toms had been present for two months. Patient denied having haematemesis, melena, diarrhoea, nausea or vomiting. There was no history of weight loss or problems with swallowing. In past medical history, she reported pneumonia many years ago, tuber- culosis of cervical lymph nodes successfully cured in 1989 and a long-term history of endogenous depression. The patient had