PMC5948316_01
A 3-mm superficial ulcer in the prepyloric antrum.
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F1
Esophagogastroduodenoscopy (EGD) revealed changes consistent with portal hypertensive gastropathy, slightly prominent gastric folds, a few sessile polyps suggestive of fundic gland polyps, and a small superficial ulcer (3-mm) in the antrum (Figure 1), which was biopsied.
A 3.1-cm intramural low-density area with peripheral enhancement involving the antrum and pyloric area concerning for abscess.
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F2
Lipase was elevated at 514 U/L, and repeat abdominal CT scan showed a new, intramural low-density area (3.1 cm) with peripheral enhancement involving the antrum and pyloric area concerning for abscess (Figure 2), thrombosis in the middle hepatic vein, and enlarged lymph nodes at the gastrohepatic ligament and near the caudate lobe of the liver.
Persistent loculated abscess in the anterior wall of the gastric antrum measuring approximately 4.8 x 6.3 x 5.0 cm.
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F3
Repeat abdominal CT scan 2 months later showed a persistent loculated cystic lesion in the anterior wall of the gastric antrum, which had increased in size since the previous CT scan (Figure 3).
(A) Hematoxylin and eosin (H&E) stain of the of stomach wall (x40). Intact gastric mucosa (single arrow) with ectopic pancreatic tissue in muscularis propria (double arrows). (B) Medium-power view (x100) of heterotopic pancreas with evidence of chronic pancreatitis. (C) H&E stain (x80) of an organizing abscess cavity lined with granulation tissue (single arrow), with adjacent dilated ducts and ectopic pancreatic tissue (double arrows).
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F4
This mass abutted the overlying gastric mucosa, which was normal and intact (Figure 4). There was a mild lymphocytic infiltrate in the stroma, which was consistent with chronic pancreatitis (Figure 4). Adjacent to the ectopic pancreatic tissue, an organizing abscess cavity lined by granulation tissue was evident with dilated and inflamed pancreatic ductules opening into it (Figure 4).