Heterotopic gastric mucosa of the cervical esophagus: A case of high-grade dysplasia treated with argon plasma coagulation and a case of adenocarcinoma

Abstract

Heterotopic gastric mucosa in the cervical esophagus appears to result from incomplete replacement of the original columnar epithelium by stratified squamous epithelium in the embryonal period. 1 Gray SW Skandalikis JE. The esophagus. in: Embryology for surgeons. The embryological basis for the treatment of congenital defects. : WB Saunders, Philadelphia1972: 63-100 Google Scholar This condition should be distinguished from the acquired metaplastic process in Barrett's esophagus that results from chronic gastro-esophageal reflux disease. 2 Feurle GE Helmstaedter V Buehring A Bettendorf U Eckardt VF Distinct immunohistochemical findings in columnar epithelium of esophageal inlet patch and Barrett's esophagus. Dig Dis Sci. 1990; 35: 86-92 Crossref PubMed Scopus (53) Google Scholar Islands of gastric mucosa, or inlet patches, are seen in 4% to 10% of patients referred for EGD. 3 Jacobs E Dehou MF. Heterotopic gastric mucosa in the upper esophagus: a prospective study of 33 cases and review of the literature. Endoscopy. 1997; 29: 710-715 Crossref PubMed Scopus (62) Google Scholar , 4 Jabbari M Goresky CA Lough J Yaffe C Daly D Cote C. The inlet patch: heterotopic gastric mucosa in the upper esophagus. Gastroenterology. 1985; 89: 352-356 Abstract PubMed Google Scholar , 5 Borhan-Manesh F Farnum JB. Incidence of heterotopic gastric mucosa in the upper esophagus. Gut. 1991; 32: 968-972 Crossref PubMed Scopus (127) Google Scholar Despite publications asserting that heterotopic gastric mucosa is a benign condition, 14 cases have so far been reported of adenocarcinoma and 1 of high-grade dysplasia arising in such an inlet patch. 6 Lauwers GY Scott GV Vauthey JN Adenocarcinoma of the upper esophagus arising in cervical ectopic gastric mucosa. Rare evidence of malignant potential of so-called “inlet patch.”. Dig Dis Sci. 1998; 43: 901-907 Crossref PubMed Scopus (60) Google Scholar , 7 Mion F Lambert R Partensky C Cherkaoui M Berger F. High-grade dysplasia in an adenoma of the upper esophagus developing on heterotopic gastric mucosa. Endoscopy. 1996; 28: 633-635 Crossref PubMed Scopus (34) Google Scholar , 8 Tagaki A Ema Y Horii S Morishita M Miyaishi O Kino I. Early adenocarcinoma arising from ectopic gastric mucosa in the cervical esophagus. Gastrointestinal Endosc. 1995; 41: 167-170 Abstract Full Text PDF PubMed Scopus (36) Google Scholar , 9 Sperling RM Grendell JH. Adenocarcinoma arising in an inlet patch of the esophagus. Am J Gastroenterol. 1995; 90: 150-152 PubMed Google Scholar Almost certainly inlet patch, and dysplasia and adenocarcinoma arising in an inlet patch, are under-diagnosed. This article presents 2 cases, one of high-grade dysplasia treated with argon plasma coagulation (APC), and one of an adenocarcinoma treated with esophageal resection arising in heterotopic gastric mucosa in the cervical esophagus.