Rare Case of Large Size Circumferential Cervical Inlet Patch

Abstract

Heterotopic Gastric Mucosa (HCM) is abnormally placed gastric mucosa outside of the stomach and can be found ubiquitously within the GI tract. The most common location is in the proximal esophagus just distal to the esophageal sphincter known as a cervical inlet patch (CIP). Due to the active secretion of acid and or mucous, clinical complications from these ectopic tissues arise as esophagitis, ulcers, webs, strictures, hoarseness, sore throat, cough, heartburn, dysphagia, odynophagia and globus sensation (lump in throat) that may necessitate screening biopsies and or serial dilatations. It is extremely rare to encounter a CIP large enough to cover the entire circumference of the esophagus seen in our patient, who presented as an asymptomatic thirty-nine year old female incidentally found to have circumferential CIPs measuring 20x28mm area in total. Although uncommon, dysplastic changes and malignancies in association with CIPs have been reported. However, this was not found in our patient as biopsy demonstrated no malignant changes. Pathology describes the lesions as gastric foveolar type surface epithelium and squamous epithelium with underlying gastric cardio-fundic type glands along with focal erosions, moderate acute and chronic inflammation. Up to date, patient continues to regularly follow up in clinic and has been doing well.Figure: Endoscopic view of an inlet patch with salmon colored gastric mucosa.Figure: Low power histology the inlet patch showing gastric mucosa and normal esophageal mucosa.Figure: High power histology of the patch showing gastric type mucosa.