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

Authors

Muslim A Enaya, Mahmood Albo Ahmed

Published in

Cureus. Volume 18. Issue 7. Pages e112653. Epub Jul 14, 2026.

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.

PMID:
42598645
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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