| Abstrakt: |
Heterotopic pancreas (HP) involving the gallbladder is a rare finding. HP is usually missed on radiology and at the time of surgery and is usually discovered incidentally at pathologic evaluation. We present a case of heterotopic pancreatic tissue in the gallbladder of a 34-year-old female who presented to the emergency department with upper right abdominal pain and vomiting. Elevated serum amylase and serum lipase levels were detected, as well as elevated bilirubin (total 37; direct 20) was also detected; clinically she was considered to have common bile duct obstruction and gallstone pancreatitis. However, abdominal ultrasound scan demonstrated a borderline enlarged gallbladder with no sonographic evidence of acute cholecystitis. Moreover, no stones were visualized in the common bile duct and a sonographically normal biliary tree was seen. No lesions were identified at cholecystectomy. Grossly, the gallbladder contained an intramural mass was detected measuring 1.5 cm. Several yellow/brown stones were present ranging in size from 0.1 cm - 0.3 cm. Histologically, sections of the gallbladder wall showed mucosa with mild chronic cholecystitis with focal intestinal metaplasia. A nodule of well-organized pancreatic tissue was present in the subserosal fat. This contained pancreatic acini and ducts as well as occasional islets. There was no evidence of acute or chronic pancreatitis. The reports of HP have shown that it most often associated with chronic cholecystitis, though this may be coincidental as the incidence in patients without gallbladder symptoms and cholecystectomy is not known. It has also occasionally presented as a gallbladder mass. HP in the gallbladder has also been reported to be associated with elevated serum amylase and lipase levels, mimicking true pancreatitis. While HP in the stomach and other sites such as small bowel is uncommon, HP tissue in the gallbladder is very rare, with less than 45 case reports identified upon literature review. We provide evidence here of another rare case of HP within the gallbladder, and describe its interesting clinical presentation, gross and histological features. [ABSTRACT FROM AUTHOR] |
