A case of gastric aberrant pancreas diagnosed with EUS-FNA

A 42-year-old man had abdominal pain. Endoscopic examination disclosed a submucosal tumor (SMT) in the greater curvature of the gastric body. Under CT examination, this SMT had a cystic lesion and inflammatory reaction was found outside of the gastric wall. Endoscopic ultrasonography (EUS) was performed and a hypoechoic mass with anechoic capillary areas occupied the third layer of the gastric wall. We suspected gastric aberrant pancreas. To confirm a diagnosis, we performed an EUS-guided fine-needle aspiration biopsy (EUS-FNA) with Echotip Ultra 22G. In addition, we punctured the cyst and measured pancreatic enzymes. The histology of the SMT was a normal pancreatic acinus. The cystic fluid AMY and Lipase level were 41360 IU/and 204000IU/l, respectively. Consequently, the confirmative diagnosis was an aberrant pancreas of the stomach. Although the symptoms were improved with conservative treatment, the patient had abdominal pain again. The CT imaging showed inflammatory exudates on the liver surface which was contiguous from aberrant pancreas. Subtotal gastrectomy was performed and resected specimen contained excretory duct, islets of Langerhans, and acinar cells, which meant an aberrant pancreas of Heinrich. Two months after the treatment, the patient had no symptoms. EUS-FNA is a powerful tool for the preoperative diagnosis of the aberrant pancreas of the stomach.