Ectopic Pancreatic Tissue

Brooke R. Jeffrey, MD

Michael P. Federle, MD, FACR

Key Facts

Terminology

Pancreatic tissue located outside normal confines of pancreas and lacking any anatomic or vascular connection with it

Imaging

Diagnostic: Small intramural gastric mass with central umbilication (45%)
- Central umbilication: Orifice of rudimentary duct within ectopic pancreas through which ectopic pancreatic tissue opens and drains into gastric lumen
- Stomach: Typically 1-2 cm in diameter, along greater curvature or posterior aspect of antrum, within 6 cm of pylorus
- Upper GI series may show narrowed pyloric channel ± polypoid or sessile mass
CT: Usually too small to be detected
- Rarely intramural cystic collection in stomach and duodenum

Top Differential Diagnoses

Gastric ulcer
- Round ulcer, smooth mound of edema, radiating folds to ulcer edge, Hampton line, ulcer collar
Gastric carcinoma
- Polypoid or circumferential mass, ± ulceration, focal wall thickening with mucosal irregularity, focal infiltration of wall
Gastric metastases and lymphoma
- “Bull’s-eye” sign: Ulceration in center of lesion
Gastric GIST
- Large, lobulated, submucosal mass with ulceration; requires biopsy and histologic diagnosis

(Left) Axial CECT demonstrates a mural mass

in the body of the stomach. Note that the mass is of soft tissue attenuation and enhances similarly to the normal pancreas. (Right) Sagittal reformation of CECT in the same patient shows the mural mass

to have broad base of attachment to the gastric wall and to have obtuse angles with the gastric lumen, suggesting a likely submucosal location for the mass. Endoscopic biopsy revealed ectopic pancreatic tissue.

(Left) Upper GI series spot film shows a small antral mass with intact mucosa. A central “dot” of barium

can be seen filling a rudimentary duct. (Right) Upper GI series spot film shows a small mass with central umbilication

. This is an unusual location for an ectopic pancreas. A “bull’seye” lesion of this type and location would raise concern for a metastatic lesion, Kaposi sarcoma, or lymphoma.