Pancreatic acinar cell metaplasia in the stomach of a 12-year-old child: An extremely rare case report

Rationale: Pancreatic acinar cell metaplasia of the gastric mucosa is characterized by the presence of clusters of pancreatic-like cells in the stomach. Although there are many instances of this condition in adults described in the medical literature, symptomatic cases in children are exceedingly rare. Patient concerns: A 12-year-old female patient presented to the pediatric clinic at Tishreen University Hospital complaining of postprandial nausea and recurrent periumbilical pain. The patient’s symptoms were not accompanied by fever, diarrhea, or constipation. The patient’s medical history was unremarkable. No abnormalities were noted on the physical examination. Diagnoses: Biopsies taken during esophagogastroduodenoscopy revealed Helicobacter pylori-positive chronic gastritis. Interventions: The patient was started on omeprazole, clarithromycin, and metronidazole triple therapy, but with minimal improvement. Six months later, esophagogastroduodenoscopy was repeated because her symptoms persisted, and antral biopsies showed clusters of pancreatic-like cells with no signs of H. pylori. Outcomes: The patient was diagnosed with pancreatic acinar cell metaplasia and put on symptomatic treatment, to no avail. One year after the initial diagnosis, esophagogastroduodenoscopy was redone, showing similar findings. Lessons: This report shows the development of pancreatic acinar cell metaplasia in a child after treatment for H. pylori. The clinical significance of pancreatic acinar cell metaplasia is not yet known because of the small number of cases documented in the literature, particularly among children.