An unusual case of double heterotopic pancreatic tissues in the same localization.

Heterotopic pancreas is defined as arising of pancreatic tissue ectopically with no anatomical, neural or vascular connection to the normal pancreas [1]. We present here an unusual case that has two heterotopic pancreatic tissues in antrum. A 31-year-old woman was admitted to our outpatient clinic with a four-month history of epigastric pain and dyspepsia. All laboratory tests of the patient were within the reference limits. She had no significant medical history and was not taking any medications. Upper gastrointestinal endoscopy revealed appearance of gastritis, and biopsies for Helicobacter pylori was taken. Also two saddle-shaped lesions in the antrum were detected. The first one of the two lesions (which was 12 mm in diameter) was located in the prepyloric antrum and the second one (which was 10 mm in diameter) was located in the proximal antrum (Figure 1). Endoscopic ultrasonography was performed in order to reveal the nature of these lesions and it revealed the diagnosis of heterotopic pancreatic tissue for both of the lesions. The first lesion in prepyloric antrum was in tubular structure, which was originating from submucosa and muscularis propria, and the second lesion was originating from submucosa. Antral biopsy revealed gastritis due to Helicobacter pylori infection and eradication therapy was performed. The heterotopic pancreatic tissues in antrum were followed up, and one year later no change in the dimensions were detected. In autopsy series, it was reported that the incidence of heterotopic pancreas varies from 0.55 to 13.7%. The most common localization of heterotopic pancreas is stomach, accounting for 25-38.2% of cases. Although it is a benign condition, a few reports have described the presence of benign and malignant neoplastic changes [2, 3, 4, 5]. Although Baysoy et al. recently described a 5-year old child with double heterotopic pancreas located in various parts of the gastrointestinal tract [6], to our best knowledge our case is unique because of the occurrence of two heterotopic pancreatic tissues in the same localization. Both of the heterotopic pancreatic lesions were in the antrum in our case.