Ectopic pancreas at the ampulla of Vater diagnosed with endoscopic snare papillectomy: A case report and review of literature

Table 1 Histological classification of ectopic pancreas

Heinrich classification (1909)

Type I - Contains acini, ducts and islands of Langerhans

Type II - Contains acini and ducts, but lacks endocrine elements

Type III Comprises proliferating ducts, exhibiting neither acini nor endocrine elements

Gasper Fuentes Classification (1973)

Type I - typical pancreatic tissue with acini, ducts, and islet cells similar to the normal pancreas.

Type II (canalicular variety) - pancreatic ducts only.

Type III (exocrine pancreas) - acinar tissue only.

Type IV (endocrine pancreas) - islet cells only.

Table 2 Summary of clinical features of patients with ectopic pancreas at the ampulla of Vater

Author	Number of cases	Age (yr)/sex	Symptoms	Tumor size (mm)	CBD dilation	Treatment
Hoelzer[7], 1940	1	54/F	Abdominal pain, jaundice	12	Yes	Inoperable
Mitchell and Augrist[8], 1943	1	68/F	N/A	5	No	N/A
Varay[9], 1946	1	44/F	Jaundice	3	Yes	Pancreaticoduodenectomy
Pearson[10], 1951	1	43/F	Abdominal pain, jaundice	25	Yes	Pancreaticoduodenectomy
Weber et al[11], 1968	1	46/F	Abdominal pain, jaundice	8	Yes	Pancreaticoduodenectomy
Vankemmel and Houcke[12], 1977	14	32-53/ NA	13 cases – chronic pancreatitis1 case – ampullary tumor	1-10 mm	NA	14 cases - Pancreaticoduodenectomy
Bill et al[13], 1982	1	64/M	Abdominal pain	40	Yes	Pancreaticoduodenectomy
O'Reilly et al[14], 1983	1	61/M	Jaundice	8	Yes	Pancreaticoduodenectomy
Laughlin et al[15], 1983	1	54/F	Abdominal pain	5	Yes	Ampullectomy
Xu[16], 19911	6	35-60 /5M/1F	6 cases - Jaundice	NA	NA	6 cases - Pancreaticoduodenectomy
Kubota et al[17], 1996	1	71/M	Abdominal pain	NA	Yes	Pancreaticoduodenectomy
Hammarström and Nordgren[18], 1999	1	NA/F	Acute pancreatitis	4	No	ERCP, Sphincterotomy & biopsy
Molinari et al[19], 2000	1	42/M	Abdominal pain, jaundice, weight loss	4	Yes	Pancreaticoduodenectomy
Chen et al[20], 2001	1	59/F	Abdominal pain	12	Yes	Ampullectomy
Contini et al[21], 2003	1	72/F	Abdominal pain, jaundice	8	Yes	Ampullectomy
Obermaier et al[22], 2004	1	46/M	Jaundice	2	Yes	Pancreaticoduodenectomy
Wagle et al[23], 2005	1	70/F	Abdominal pain, jaundice	NA	Yes	Pancreaticoduodenectomy
Filippou et al[24], 2006	1	69/F	Jaundice, weight loss	NA	Yes	Ampullectomy
Karahan et al[25], 2006	1	67/M	Abdominal pain, jaundice	10	Yes	Laparotomy, biopsy, Choledochojejunostomy
Biswas et al[26], 2007	1	47/M	Abdominal pain, jaundice	15	Yes	Pancreaticoduodenectomy
Hsu et al[27], 2008	1	54/M	Abdominal pain, jaundice	NA	Yes	Pancreaticoduodenectomy
Rao et al[28], 2011	1	48/M	Jaundice	1.5	Yes	Pancreaticoduodenectomy
Ciesielski et al[29], 2015	1	54/M	Abdominal pain, jaundice	NA	No	Cholecystectomy with intraoperative CBD BX
Kang et al[30], 20162	1	39/F	-	14	No	Endoscopic resection
Nari et al[31], 2019	1	49/M	Abdominal pain, Jaundice	NA	Yes	Cholecystectomy with CBD Exploration and Bx; Papillo - Sphincterotomy
Present case, 2021	1	71/M	Abdominal pain	8	Yes	Endoscopic snare papillectomy
Total no of cases	44

¹Article in Chinese language.

²Article in Korean language.

Ampullary gangliocytic paraganglioma along with ectopic pancreas. CBD: Common bile duct; N/A: Not applicable; NA: Not available.