Korean J Gastroenterol.  2022 Oct;80(4):195-199. 10.4166/kjg.2022.078.

Ectopic Pancreas with Walled-off Necrosis Mimicking Malignant Submucosal Gastric Tumor

  • 1Departments of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
  • 2Departments of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea


An ectopic pancreas rarely transforms into a malignancy, and the symptoms vary from patient to patient. The most commonly observed site of an ectopic pancreas is the antrum of the stomach. A 59-year-old male patient with severe abdominal pain underwent CT. A 9.6 cm-sized well-defined exophytic huge mass with heterogenic density was located between the stomach distal antrum and duodenum. A malignant submucosal tumor was suspected because of the exophytic dirty huge mass. Initially, surgery was considered to confirm the histological evaluation. After 2 months, the abdominal pain disappeared, and the follow-up MRI scan showed a decrease in size, which contained a necrotic component inside. It was confirmed that the parenchymal tissue was the pancreas. The pathology through EUS-guided fine needle aspiration (EUS-FNA) was normal pancreatic acinar cells, smooth muscle fragments, squamous cyst, and some neutrophils (abscess). Walled-off necrosis occurs as a complication of acute pancreatitis with parenchymal tissues and surrounding tissues, but complications of ectopic pancreatitis occurred in this case. Abdominal pain due to ectopic pancreas leading to the formation of a giant abscess has been reported as a very rare case. Diagnosis through biopsy is most important when a malignant submucosal tumor is suspected. In addition, it is important to determine the clinical features, examination findings, such as EUS, CT, and MRI, and the changes according to the follow-up period. This paper reports a case of ectopic pancreas, resulting in necrotic tissue and walled-off necrosis, abdominal pain, and spontaneous improvement.


Ectopic pancreas; Gastric submucosal tumor; Walled off necrosis


  • Fig. 1 Abdominal pelvis computed tomography. (A, B) Necrotic mass-like lesion abutting the stomach distal antrum and duodenum occupying omentum and mesentery was noticed in coronal view. (C) Severe necrosis and abscess changes were observed in the axial view.

  • Fig. 2 (A) Esophagogastroduodenoscopy. The uneven surface without a loss of mucosa was observed on the antrum posterior wall. (B) Endoscopic ultrasonography. A huge hyperechoic lesion was noted.

  • Fig. 3 Pancreas magnetic resonance imaging (pre- & post-contrast)+diffusion. Probable necrotizing pancreatitis with walled-off necrosis arising from ectopic pancreas rather than a malignant condition. (A) High signal intensity was observed in fat-suppressed pre-contrast T1-weighted image. (B) Soft tissue contains microcystic or microductular structure in the T2-weighted image. (C) High signal intensity was observed in the 3 min delayed-coronal view.

  • Fig. 4 (A) A 3×4 cm-sized heterogeneous echogenic mass observed in the antrum. (B) Endoscopic ultrasound-guided fine-needle aspiration. Cytology and biopsy were performed twice with a 19G needle.

  • Fig. 5 Histology examination. (A) normal pancreatic acinar cells. (B) Smooth muscle fragments. (C) Neutrophils (abscess). (D) Squamoid cyst.


1. Liu X, Wu X, Tuo B, Wu H. 2021; Ectopic pancreas appearing as a giant gastric cyst mimicking gastric lymphangioma: a case report and a brief review. BMC Gastroenterol. 21:151. DOI: 10.1186/s12876-021-01686-9. PMID: 33823798. PMCID: PMC8022400.
2. Flores A, Papafragkakis C, Uberoi AS, Thaiudom S, Bhutani MS. 2018; EUS of an atypical ectopic pancreas. Endosc Ultrasound. 7:216–217. DOI: 10.4103/eus.eus_111_17. PMID: 29697071. PMCID: PMC6032704.
3. Kung JW, Brown A, Kruskal JB, Goldsmith JD, Pedrosa I. 2010; Heterotopic pancreas: typical and atypical imaging findings. Clin Radiol. 65:403–407. DOI: 10.1016/j.crad.2010.01.005. PMID: 20380941.
4. Cazacu IM, Luzuriaga Chavez AA, Nogueras Gonzalez GM, Saftoiu A, Bhutani MS. 2019; Malignant transformation of ectopic pancreas. Dig Dis Sci. 64:655–668. DOI: 10.1007/s10620-018-5366-z. PMID: 30415408.
5. Alastal Y, Khalil B, Singh S, Almadani SB. 2018; Ectopic pancreas in the gastric antrum wall complicated by ectopic pancreatitis and persistent gastric abscess. ACG Case Rep J. 5:e34. DOI: 10.14309/crj.2018.34. PMID: 29774224. PMCID: PMC5948316.
6. Kaneda M, Yano T, Yamamoto T, et al. 1989; Ectopic pancreas in the stomach presenting as an inflammatory abdominal mass. Am J Gastroenterol. 84:663–666.
7. Manikkavasakar S, AlObaidy M, Busireddy KK, et al. 2014; Magnetic resonance imaging of pancreatitis: an update. World J Gastroenterol. 20:14760–14777. DOI: 10.3748/wjg.v20.i40.14760. PMID: 25356038. PMCID: PMC4209541.
8. Pamuklar E, Semelka RC. 2005; MR imaging of the pancreas. Magn Reson Imaging Clin N Am. 13:313–330. DOI: 10.1016/j.mric.2005.03.012. PMID: 15935314.
9. Heyn C, Sue-Chue-Lam D, Jhaveri K, Haider MA. 2012; MRI of the pancreas: problem solving tool. J Magn Reson Imaging. 36:1037–1051. DOI: 10.1002/jmri.23708. PMID: 23090915.
Full Text Links
  • KJG
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr