What does this research mean for the field?

Fibroblast activation protein inhibitor (FAPI) avidity can occur in benign inflammatory conditions such as inflamed gastric ectopic pancreas and should be interpreted as a marker of fibroblast activation rather than definitive proof of malignancy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This report examines the challenges in diagnosing gastric ectopic pancreas that mimics malignancy through imaging techniques.

July 16, 2026Cureus0 citationsOpen Access

A Fibroblast Activation Protein Inhibitor (FAPI)-Avid Gastric Antral Mass Mimicking Advanced Gastric Cancer: A Case of Presumed Inflamed Gastric Ectopic Pancreas

MEMuslim A Enaya MAMahmood Albo Ahmed

Key Points

This report examines the challenges in diagnosing gastric ectopic pancreas that mimics malignancy through imaging techniques.
Case report of a 33-year-old woman with acute epigastric pain.
Diagnostic tools included endoscopy, contrast-enhanced CT, FAPI PET, endoscopic ultrasound, and immunohistochemistry.
Treatment involved H. pylori eradication therapy and conservative management.
Contrast-enhanced CT indicated irregular thickening and perigastric lymphadenopathy, raising suspicion of malignancy.
Biopsy revealed chronic gastritis with no malignancy; endoscopic ultrasound showed spindle cells and mild atypia.
Follow-up showed resolution of symptoms and antral thickening after treatment, confirming diagnosis of inflamed ectopic pancreas.

Abstract

Gastric ectopic pancreas is an uncommon congenital anomaly that is usually asymptomatic but can mimic gastric malignancy when inflamed. We report the case of a 33-year-old previously healthy woman who presented with acute severe epigastric pain and inability to tolerate oral intake. Endoscopy demonstrated annular thickening of the gastric antrum, congested and friable mucosa, and poor gastric distensibility. Contrast-enhanced computed tomography demonstrated irregular circumferential antral wall thickening with an enhancing endoluminal mass, perigastric lymphadenopathy, and minimal free intraperitoneal fluid, raising a strong suspicion for gastric malignancy. Fibroblast activation protein inhibitor positron emission tomography demonstrated a tracer-avid gastric antral lesion. Endoscopic ultrasound showed a large hypoechoic mural lesion with loss of normal wall-layer architecture and perigastric lymph nodes. Conventional biopsy showed Helicobacter pylori-associated chronic gastritis without malignancy, while endoscopic ultrasound-guided sampling revealed spindle cells with eosinophilic inflammatory infiltrate and only mild cytological atypia. Immunohistochemistry helped exclude gastrointestinal stromal tumour, schwannoma, carcinoma, and inflammatory myofibroblastic tumour. Following H. pylori eradication therapy and conservative management, symptoms resolved completely. Repeat endoscopy at three months demonstrated resolution of antral thickening and a residual centrally umbilicated subepithelial lesion, supporting the presumed inflamed gastric ectopic pancreas. This case highlights that fibroblast activation protein inhibitor avidity should be interpreted as a marker of fibroblast activation rather than proof of malignancy and that interval reassessment can prevent unnecessary radical surgery in clinically stable patients with discordant imaging and histology.

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