Endoscopic resection of ectopic pancreas in the minor papilla

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A 50-year-old Korean man underwent upper endoscopy in our hospital for the evaluation of dyspepsia. He had no significant medical history and was taking no medication.

He was found to have a hard mass with normal-appearing overlying mucosa on the minor papilla area just proximal to the normal major papilla ([Fig. 1]). Back-to-back duodenoscopy showed the lesion as more prominent. Endoscopic ultrasonography (EUS) was carried out to further evaluate the lesion. Using a 12-MHz transducer, a five-layered gastric wall structure was imaged. EUS revealed a round hypoechoic inhomogeneous lesion, with a few anechoic structures inside, originating from the submucosal layer ([Fig. 2]). The lesion was measured as 9.5 × 5.0 mm in size.

The lesion was successfully removed with a snare by endoscopic mucosal resection ([Fig. 3]). Microscopic examination revealed the mass to be composed of pancreatic acini, ducts, and foci of Langerhans islets, consistent with ectopic pancreas ([Fig. 4]). This is a rare case of submucosal tumor of the minor papilla.

Fig. 1 A hard mass with normal-appearing overlying mucosa was found in the minor papilla area.

Fig. 2 Endoscopic ultrasound image of lesion.

Fig. 3 The lesion was removed by endoscopic mucosal resection.

Fig. 4 The lesion was composed of pancreatic acini, ducts, and foci of Langerhans islets, consistent with ectopic pancreas (hematoxylin and eosin stain, × 200).

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