Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):205-208. 10.14701/ahbps.24-190.

Heterotopic pancreas of the gallbladder: A case report of a rare and commonly incidental finding

• Chen N
• Gu J

• KMID: 2568270
• DOI: http://doi.org/10.14701/ahbps.24-190

Abstract

Heterotopic pancreas (HP) refers to the presence of ectopic pancreatic tissue located outside of the normal pancreatic location without anatomical or vascular continuity with the pancreas. HP within the gallbladder (HPGB) was first described by Otschkin in 1916. It remains an exceedingly rare pathology with few reported cases. Here we describe a case of HPGB in a 42-year-old female following laparoscopic cholecystectomy for symptoms of biliary colic. She presented with epigastric pain, elevated levels in liver function tests, and gallbladder sludge on ultrasound. Her lipase and bilirubin levels were within normal limits. Histopathological assessment of the gallbladder identified mild chronic cholecystitis and pancreatic heterotopia adjacent to the cystic duct of the gallbladder with all three elements (ducts, acini, and endocrine islets) of the pancreas, consistent with type 1 based on the classification of Gaspar Fuentes et al. HPGB is often diagnosed incidentally during histopathological examination after cholecystectomy. Preoperative diagnosis is challenging due to its rarity. It is thought to be asymptomatic. Although the clinical significance of HPGB remains uncertain, it has been hypothesized that HPGB can cause acalculous cholecystitis and also have the potential for malignant transformation. Our case supports the theory that the exocrine function of an ectopic pancreatic tissue may contribute to chronic inflammation in the gallbladder. In conclusion, although HPGB is a rare finding with unclear clinical relevance, its potential for malignancy and association with cholecystitis warrant further investigation. Given its scarcity, most knowledge about HPGB comes from case reports and case series. This report adds to the existing literature.

Keyword

Heterotopic pancreas; Pancreas; Gallbladder; Ectopic pancreatic tissue; Case report

Figure

• 

  Fig. 1 Low power view of heterotopic pancreatic tissue adjacent to the cystic duct of the gallbladder. A circumscribed nodule of pancreatic tissue is centered within the sub-serosal adipose tissue underlying the gallbladder wall (H&E, 12.5×).

• 

  Fig. 2 The heterotopic pancreatic tissue demonstrating all three elements, including serous acini, exocrine ducts, and pancreatic islets (H&E, 100×).

Reference

References

1. Kantor M, Eiseler S, Schiller A, Hughes S, Liu X, Lai J. 2018; Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: a case report and literature review. Clin Res Hepatol Gastroenterol. 42:e72–e76. DOI: 10.1016/j.clinre.2018.02.001. PMID: 29625925.

2. Gucer H, Bagci P, Coskunoglu EZ, Karadag C. 2011; Heterotopic pancreatic tissue located in the gallbladder wall. A case report. JOP. 12:152–154.

3. Klob J. Pancreas accessorium. Zeitschrift der Kaiserl. 1859; 15:732.

4. Elhence P, Bansal R, Agrawal N. 2012; Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis. Int J Appl Basic Med Res. 2:142–143. DOI: 10.4103/2229-516X.106360. PMID: 23776830. PMCID: PMC3678697.

5. Sato A, Hashimoto M, Sasaki K, Matsuda M, Watanabe G. 2012; Elevation of pancreatic enzymes in gallbladder bile associated with heterotopic pancreas. A case report and review of the literature. JOP. 13:235–238.

6. Aborajooh E, Ghayada IKK, Lafi YMI. 2021; Heterotopic pancreas in the gallbladder: case report and literature review. Case Rep Med. 2021:6611291. DOI: 10.1155/2021/6611291. PMID: 33564313. PMCID: PMC7867455.

7. Elpek GO, Bozova S, Küpesiz GY, Oğüş M. 2007; An unusual cause of cholecystitis: heterotopic pancreatic tissue in the gallbladder. World J Gastroenterol. 13:313–315. DOI: 10.3748/wjg.v13.i2.313. PMID: 17226916. PMCID: PMC4065965.

8. https://doi.org/10.4103/jcrt.jcrt_2682_22. DOI: 10.4103/jcrt.jcrt_2682_22. PMID: 38261462.

9. Qizilbash AH. 1976; Acute pancreatitis occurring in heterotopic pancreatic tissue in the gallbladder. Can J Surg. 19:413–414.

10. Ormarsson OT, Gudmundsdottir I, Mårvik R. 2006; Diagnosis and treatment of gastric heterotopic pancreas. World J Surg. 30:1682–1689. DOI: 10.1007/s00268-005-0669-6. PMID: 16902740.

11. Huang YC, Chen HM, Jan YY, Huang TL, Chen MF. 2002; Ectopic pancreas with gastric outlet obstruction: report of two cases and literature review. Chang Gung Med J. 25:485–490.

12. Pendharkar D, Khetrapal S, Jairajpuri ZS, Rana S, Jetley S. 2019; Pancreatic and gastric heterotopia in the gallbladder: a rare incidental finding. Int J Appl Basic Med Res. 9:115–117. DOI: 10.4103/ijabmr.IJABMR_109_18. PMID: 31041176. PMCID: PMC6477957.

13. Gaspar Fuentes A, Campos Tarrech JM, Fernández Burgui JL, Castells Tejón E, Ruíz Rossello J, Gómez Pérez J, et al. 1973; Ectopias pancreáticas [Pancreatic ectopias]. Rev Esp Enferm Apar Dig. 39:255–268. Spanish.

14. Al-Shraim M, Rabie ME, Elhakeem H, Kandeel A, Shah MT, Jamil S. 2010; Pancreatic heterotopia in the gallbladder associated with chronic cholecystitis: a rare combination. JOP. 11:464–466.

15. Fukino N, Oida T, Mimatsu K, Kuboi Y, Kida K. 2015; Adenocarcinoma arising from heterotopic pancreas at the third portion of the duodenum. World J Gastroenterol. 21:4082–4088. DOI: 10.3748/wjg.v21.i13.4082. PMID: 25852297. PMCID: PMC4385559.

16. Yang YB, Liu YQ, Dai L, Yan WP, Liang Z, Chen KN. 2022; Malignant transformation of heterotopic pancreas as middle esophagus adenocarcinoma-a rare case report and comprehensive literature review. Thorac Cancer. 13:1083–1087. DOI: 10.1111/1759-7714.14344. PMID: 35253375. PMCID: PMC8977157.

17. Yeo DXW, Goh N, Chuah KL, Amitbhai SK, Oo AM, Ahmed AKS, et al. 2021; Malignant transformation of heterotopic pancreatic tissue in a patient with BRCA2 mutation. Gastroenterol Insights. 12:10–16. DOI: 10.3390/gastroent12010002.

18. Xiong Y, Xie Y, Jin DD, Wang XY. 2020; Heterotopic pancreas adenocarcinoma in the stomach: a case report and literature review. World J Clin Cases. 8:1979–1987. DOI: 10.12998/wjcc.v8.i10.1979. PMID: 32518790. PMCID: PMC7262711.

19. Kaneko T, Ohara M, Okamura K, Fujiwara-Kuroda A, Miyasaka D, Yamabuki T, et al. 2019; Adenocarcinoma arising from an ectopic pancreas in the duodenum: a case report. Surg Case Rep. 5:126. DOI: 10.1186/s40792-019-0684-8. PMID: 31388774. PMCID: PMC6684697.