Pancreatic Pathology Online

Pathology of Heterotopic (Ectopic) Pancreas or Accessory Pancreas

 Dr Sampurna Roy MD         July 2016


Pancreatic tissue is present outside its normal location.

Heterotopic (ectopic) pancreas, which is incidentally found in 2% of all routine postmortem examinations.   

This anomaly is most commonly localized in the wall of the stomach, duodenum and jejunum.

 Heterotopic (ectopic) pancreas is an incidental finding in the stomach, duodenum, jejunum, Meckel's diverticulum of the ileum, the common bile duct, gall bladder, liver, spleen.




More rarely, it has been found in Meckel's diverticulum of the ileum, the common bile duct, gall bladder, liver, spleen and various other foci in the abdominal cavity.

In the wall of the gastrointestinal tract, pancreatic nodules localize immediately below the mucosa, in the muscularis beneath the serosa, or in small diverticula.

The tissue contains all the components of normal pancreas, namely, acini, ducts, and islets.

The most plausible theories of the origin of Heterotopic pancreas are:

(1) Incomplete atrophy of the left ventral anlage;

(2) Regression to a more primitive pattern of differentiation reminiscent of that seen in lower vertebrates, especially certain fish in which exocrine and endocrine pancreatic tissue are diffusely distributed in liver, intestinal wall, and peritoneum;

(3) Inappropriate expression of the pleuripotent developmental capacity of the embryonic gut;

(4) Buds of embryonic pancreatic tissue that have penetrated the intestinal wall and have become isolated from the main mass and thus misplaced by rapid longitudinal growth of the intestine.

Of these theories, the last two (3) and (4) seem more probable.


Further reading:

Heterotopic pancreas: a clinical analysis of nine patients and review of literature.

Adenocarcinoma arising from intrahepatic heterotopic pancreas: a case report and literature review.

Heterotopic pancreas: a clinical analysis of nine patients and review of literature.

Elevation of pancreatic enzymes in gallbladder bile associated with heterotopic pancreas. A case report and review of the literature.

Duodenal heterotopic pancreatic tissue: a case report and literature review.

Heterotopic pancreas in the stomach (type II according to Heinrich) - literature review and case report.

Pancreatic heterotopia: a reappraisal and clinicopathologic analysis of 32 cases.

Heterotopic pancreas. Review of a 26 year experience.

Ductal adenocarcinoma arising in a heterotopic pancreas situated in a hiatal hernia.

Ectopic pancreas with gastric localization: a clinical case and review of the literature].

Heterotopic pancreas as a rare cause of gastrointestinal hemorrhage in the newborn: report of a case.



Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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