Heterotopic pancreatic tissue in the gallbladder

Abstract

Heterotopic pancreas is defined as aberrantly located pancreatic tissue without anatomical, vascular, or neural connection to the pancreas. Usual sites include the stomach, duodenum, jejunum, and spleen; in rare cases, heterotopic pancreas can be found in the lungs, gallbladder, Meckel's diverticulum, and the mediastinum. In most cases, it is an insignificant, incidental finding. Pre-operative diagnosis is not possible, and histopathological examination is mandatory for establishing a definite diagnosis. Less than 40 cases of heterotopic pancreas in the gallbladder have been reported worldwide. Recently, a laparoscopic cholecystectomy specimen from a 43-year-old male showed a small nodule in the gallbladder neck. Microscopy revealed heterotopic pancreas composed of exocrine and endocrine glandular tissue with ducts. We report this case to highlight this rare, incidental finding. This condition should not cause pathologists to over diagnose such occurrences as malignancies; neither should they be neglected because they have potential complications.

Figure 1

Heterotropic pancreas in gallbladder (hematoxylin and eosin stain, 10X) showing: surface epothelium of gallbladder (red arrow), pancreatic acini (blue arrow), pancreatic duct (green arrow), and islet of langerhans (black arrow).

Figure 2

Timeline summarizing the patient’s information, clinical findings, investigations, preoperative diagnosis, therapeutic intervention, histopathology, and follow up.