A 34-year old woman who presented with left shoulder tip pain. This was followed by epigastric pain. An endoscopy showed two small leiomyoma only. A
CT scan showed a cystic mass in the epigastrium. This appeared to extend up through the hiatus. A provisional diagnosis of a predominantly Extragastric gastrointestinal stromal tumor (GIST) was made.
An angiogram showed the left gastric vessels were distorted over the tumor.
At operation a dense inflammatory mass was found at the cardia of the stomach.
It appeared to arise from the lower oesophagus and was adherent to the hiatus, diaphragm, under surface of the left lobe of the liver and the lesser omentum.
The pancreas was normal. The photograph shows the mobilised mass with its
'stalk' to the muscle of the lower esophagus. The undersurface of the left lobe of the liver can be seen. There is a split in the capsule.
The histology of the resected mass showed ectopic pancreas. Presumably the patient's symptoms were due to 'pancreatitis,' and the operative findings of dense inflammation were consistent with such a process. The CT findings of a cystic component in the mass might suggest pseudocyst formation.
Ectopic pancreas may be found in 1 in 500 laparotomies and the stomach is the usual site for the tissue to be found. The ectopic pancreatic tissue is usually submucosal and less than 3 cm diameter.
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