Case Of Heterotopic Gastric Mucosa Research Articles

A rare case of heterotopic gastric mucosa of the rectum with complete intestinal metaplasia highlighting the utility of molecular microsatellite testing in diagnostic corroboration

Heterotopic gastric mucosa (HGM) is common in the esophagus but exceedingly rare in other sites. Only 73 cases of HGM of the rectum

Triple gallbladder with heterotopic gastric mucosa: a case report

BackgroundTriple gallbladder is a rare congenital anomaly of the biliary tract that can be associated with heterotopic tissue. Gallbladder triplication results from the failure of rudimentary bile ducts to regress during embryological development, and can be difficult to distinguish from Todani type II choledochal cysts and biliary duplication cysts.Case presentationA 2-year-old patient presented to our institution with intermittent abdominal pain for 1 year. She had elevated transaminases with imaging concerning for a choledochal cyst. After assessment with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography, she was diagnosed with a gallbladder multiplication and a common bile duct stricture. She underwent laparoscopic cholecystectomy, which confirmed the diagnosis of triple gallbladder. One of the three gallbladders demonstrated heterotopic gastric mucosa on final pathology, including at the cystic duct margin. Follow up testing with a technetium 99 m scan demonstrated a subtle focus of increased activity in the right upper abdomen at the expected location of the common bile duct, concerning for the presence of residual gastric mucosa. The patient remains well without abdominal pain.ConclusionsWe describe the first case of heterotopic gastric mucosa in a triple gallbladder in a young patient presenting with chronic abdominal pain. We also demonstrate the safety and feasibility of laparoscopic cholecystectomy in young children with triple gallbladder. Finally, we propose an interdisciplinary approach to the management of common bile duct strictures in the setting of ectopic acid secretion, involving a combination of medical management, endoscopic intervention, and possible salvage laparoscopic Roux-en-Y hepaticojejunostomy.

Bile duct obstruction secondary to heterotopic gastric mucosa

Abstract Background We present the first reported case of heterotopic gastric mucosa (HGM) with pyloric type metaplasia obstructing the bile duct, with a literature review of bile duct obstruction from other types of HGM in children and adults. Case presentation A 10-year old boy presented with severe, episodic, post-prandial, epigastric pain. An extensive work-up found a partially obstructing lesion of the common bile duct adjacent to the cystic duct. He underwent surgical resection of the lesion with restoration of the biliary drainage via choledocho-duodenostomy. Pathology revealed heterotopic gastric mucosa with pyloric metaplasia. Recovery was uneventful and he remains symptom-free 36 months later. Conclusions Obstructing lesions of the biliary tree are exceedingly rare in children. In contrast with adults, there is minimal concern that such a lesion represents a malignancy. This may lead to prolonged diagnostic work-up as opposed to early surgical exploration. While it can be difficult to differentiate between benign and high-risk bile duct lesions in adults, malignant transformation of HGM of the bile duct has only been reported in an adult. In every pediatric and adult case reviewed, surgical exploration was required to establish the diagnosis. Our patient's pathology revealed pyloric type metaplasia as a component of HGM. This is the first report of pyloric type metaplasia in the literature. Previously reports have only shown HGM of fundic origin. We advocate early resection of these lesions for both diagnostic purposes, and due to the potential for malignant transformation.

Acute scrotum due to heterotopic gastric mucosa in Tunica vaginalis

Abstract In adult and pediatric literature, most cases of heterotopic gastric mucosa are reported in gastrointestinal tract. Presences of gastric mucosa in genitourinary tract is unusual. We review the literature and report a case of 10-year old boy who presented with acute scrotum due to ulceration and bleeding from heterotopic gastric mucosa located in Tunica vaginalis. Excision of ectopic mucosa and Patent Processus vaginalis (PPV) was curative.

Heterotopic Gastric Mucosa in the Common Bile Duct With Cholangiocarcinoma

Gastric heterotopia within the biliary system is extremely rare. Moreover, the combination of gastric heterotopia in the bile duct with cholangiocarcinoma has not been reported. We describe a case of heterotopic gastric mucosa in the common bile duct with cholangiocarcinoma. An 80-year-old male was admitted with abdominal pain. Abdominal computed tomography revealed wall thickening from the hilar duct to the distal common bile duct. Biopsy from the distal bile duct showed only benign gastric foveolar-type epithelium and fundic glands. Although the diagnosis of the biopsy was benign, malignancy was strongly suspected from the radiologic findings, and excision of the bile ducts was performed. Microscopically, the resected specimen showed poorly formed malignant glands and gastric heterotopia also identified in the common bile duct. Three months later, the patient's state worsened due to recurrence, and he died. To our knowledge, this is the first report of gastric heterotopia in the bile duct accompanying cholangiocarcinoma.

A Case of Heterotopic Gastric Mucosa of the Ileum Without Meckel's Diverticulum

A Case of Heterotopic Gastric Mucosa of the Ileum Without Meckel's Diverticulum

Efficient Genetic Analysis of Microdissected Samples by Agarose-Bead Method: Alterations of β-Catenin Gene in Fundic Gland Polyp and Heterotopic Gastric Mucosa of Duodenum

Molecular genetic analyses of archival formalin-fixed, paraffin-embedded (FFPE) pathological specimens taken at biopsy or autopsy, are occasionally compromised because the DNA molecules therein are inevitably degraded. Furthermore, since these tissue samples comprise various cell types, the analyses based on mixtures of such heterogeneous populations often fail to reflect the nature of the affected cells. In the present study, to elucidate the contribution of β-catenin gene mutation to the fundic gland polyp and the heterotopic gastric mucosa in the duodenum, we successfully introduced an agarose-bead mediated technique as an effectual tool for retrospective morphology-oriented genetic analyses. Microdissected samples were embedded in low-melting agarose, and directly treated with proteinase K. A fragment of the agarose-bead was used as a template for polymerase chain reaction to analyze β-catenin mutation. Of the six cases of heterotopic gastric mucosa in the duodenum associated with fundic gland polyps, one showed a common 1-bp missense mutation at codon 37 shared by both the fundic gland polyp and the heterotopic gastric mucosa. Alternatively, a 1-bp silent mutation at codon 33 and missense mutation at codon 32 were identified only in the heterotopic gastric mucosa. Agarose-bead mediated technique shows superior sensitivity to the previously described techniques and is an effectual tool for retrospective morphology-oriented genetic analyses using a large number of archival pathological samples stored for long periods in the pathology laboratory.

Heterotropic Gastric Mucosa in Sigmoid Colon: Report of One Case

In this case presentation we aimed to discuss, with literature, a female patient with rarely seen sigmoid localized heterotopic gastric mucosa. An approximate 0.5 – 1 cm polyp was determined in the rectosigmoidoscopy of the 37-year-old female patient who had applied to the general surgery department with a constipation complaint. Heterotopic gastric mucosa was detected as a result of histopathological examination. Heterotopic gastric mucosa is frequently determined in the upper gastrointestinal tract. The number of cases of heterotopic gastric mucosa localized on the lower gastrointestinal tract is considerably low in literature.

Clinical evaluation of twenty cases of heterotopic gastric mucosa of upper esophagus during five-year observation, using gastroscopy in combination with histopathological and microbiological analysis of biopsies

Aim of the studyHeterotopic gastric mucosa of the upper esophagus (HGMUE) may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. Furthermore, HGMUE may be the origin of malignant progression to cervical esophageal carcinoma.Material and methodsIn this work, 20 patients with diagnosed heterotopic gastric mucosa of the upper esophagus (HGMUE) were subjected to 5-year follow-up to determine the extent and structure of histopathological changes within HGMUEs, as well as HGMUE dysplasia and metaplasia, and risk of their malignant transformation. As a diagnostic tool to describe localization, form, size and surface feature of HGMUEs, endoscopy was used. At the same time, the biopsies were collected for histopathological and microbiological analysis.ResultsIn examined patients, HGMUEs were associated with inflammation, chronic gastritis, hiatus hernia, duodenal bulb erosion and ulcer and infection of H. pylori. Intestinal metaplasia and low grade dysplasia were also indicated. During 5 years of observation, both the clinical and histopathological image of diagnosed HGMUEs was stable. The patients with detected presence of H. pylori were treated with triple or quadruple therapy.These results show that HGMUEs may be associated with severe complications in the gastrointestinal tract, such as infection by H. pylori, hiatus hernia or duodenal ulcer. Although dysplasias and metaplasias found in diagnosed HGMUEs were not very numerous and relatively stable both clinically and histopathologically, at the present stage of the study we cannot exclude the possibility of HGMUE malignant transformation.

Heterotopic gastric mucosa in the hilar bile duct mimicking hilar cholangiocarcinoma: report of a case

We herein report a case of heterotopic gastric mucosa in the hilar bile duct. An asymptomatic 58-year-old male was noted to have mild liver dysfunction in March 2009 during the follow-up for angina pectoris. Abdominal-enhanced CT revealed wall thickening from the upper common hepatic bile duct to the left hepatic bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis at the junction of the left hepatic bile duct. Although the patient's serum tumor markers were all within the normal ranges, the possibility of malignant disease of the biliary tree could not be ruled out. Left hepatectomy with the caudate lobe and resection of the extrahepatic bile duct were performed. Histopathologically, the resected specimen showed a polypoid lesion measuring 2 × 2 cm in size that projected into the lumen of the left hepatic bile duct. Microscopic examination revealed this polypoid lesion to be composed of mucous glands resembling gastric fundic glands, with parietal and chief cells. We also review eight other reports of heterotopic gastric mucosa in the biliary tree previously published in the English literature.

Heterotopic gastric mucosa of the anus associated with anal ulcer

Heterotopic gastric mucosa is a congenital anomaly that can occur throughout the gastrointestinal tract. It has been reported in the tongue, duodenal bulb, small bowel, pancreas, gallbladder, and in the cervical esophagous ‘‘inlet patch.’’ Heterotopic gastric mucosa is extremely rare in the anorectal region [1]. We report the case of a 57-year-old man who presented with worsening anal pain and bleeding. Five years prior to current presentation, an 8-mm sessile polyp was noted in the distal rectum. Forceps biopsy of the lesion revealed heterotopic gastric mucosa. Since the patient’s symptoms were not severe, no further intervention was done. However due to the progression of his symptoms, colonoscopy was performed and revealed a flat lesion in the distal rectum (Fig. 1). Repeat biopsy confirmed benign heterotopic gastric mucosa. Because of his worsening symptoms, the patient was referred for colorectal surgical consultation. Upon further questioning, he reported a 10-year history of intermittent bright red blood per rectum, as well as post-defecation anal pain and burning. Anoscopy demonstrated a large posterior midline ulcer. Various treatment options were discussed with the patient, and he elected to proceed with surgical intervention. He underwent transanal excision of the distal rectal lesion in addition to debridement of the anal ulcer. Gross evaluation showed a 3.5 9 2.4 9 0.8 cm area of purple and pink smooth mucosa. Histopathologic assessment revealed an 8-mm focus of benign heterotopic gastric tissue. Within 2 months of the operation, the anal ulcer had healed completely and the patient’s symptoms have resolved. Heterotopic gastric mucosa has been reported throughout the gastrointestinal tract. Its presence in the anorectal region is extremely rare with only 43 cases described in the literature. Of these cases, only 11 occurred in the anal region [1]. To the best of our knowledge, this is the first case of heterotopic gastric mucosa of the distal rectum associated with an anal ulcer. Of the 39 cases reviewed by Steele [2], the presenting symptoms included painless rectal bleeding (68%), perianal ulceration (24%), anal pain (11%), abdominal pain (11%), and melena (3%). The most

Two Cases of Heterotopic Gastric Mucosa in the Duodenal Bulb with Acid Secretion Demonstrated by Congo Red Dye Spraying Method

Two Cases of Heterotopic Gastric Mucosa in the Duodenal Bulb with Acid Secretion Demonstrated by Congo Red Dye Spraying Method

Heterotopic gastric mucosa of the gastrointestinal tract: A histopathologic study of 158 cases

The author retrieved and retrospectively investigated biopsy specimens of heterotopic gastric mucosa registered in our computer database. There were 1008 cases affecting the esophagus, 684 cases affecting the duodenum, and 1636 cases affecting the colorectum. A total of 158 cases of heterotopic gastric mucosa were identified (84 cases affecting the esophagus, 74 cases affecting the duodenum, and no case affecting the colorectum). The frequency amounted to 8% in the esophagus, 11% in the duodenum, and 0% in the colorectum. The male to female ratio was 112:46, and the mean age was 62.22±14.29 years. Pathologically, two types of heterotopic gastric mucosa were identified. The first type consisted of gastric glands and foveolar epithelium, and the second type was composed only of foveolar epithelium. The first type was recognized in 69 of 84 cases (82%) in the esophagus, and in 54 of 74 cases (73%) in the duodenum. The second type was encountered in 15 of 84 cases (18%) in the esophagus, and in 20 of 74 cases (27%) in the duodenum. The first type appeared to be of congenital origin, while the second type was reminiscent of foveolar metaplasia. Foveolar hyperplasia and mild lymphocytic infiltration were frequent in the heterotopic gastric mucosa. Goblet cell metaplasia was recognized in 11 cases. The most frequent clinical diagnosis of heterotopic gastric mucosa of the esophagus was heterotopic gastric mucosa, followed in order by iodine-unstained area, reflux disease, flat elevation, polyp, carcinoma, ulcer, erosion, redness, submucosal tumor, esophagitis, adenoma, and tumor. The most frequent clinical diagnosis of heterotopic gastric mucosa in the duodenum was polyp, followed in order by ulcer, tumor, submucosal tumor, carcinoma, and duodenitis. The data suggest that esophageal gastric mucosa and duodenal heterotopic gastric mucosa are common lesions, with a frequency of about 9% in biopsy specimens in Japan.

Heterotopic gastric mucosa in the gallbladder: Report of two cases

This report presents two cases of heterotopic gastric mucosa in the gallbladder. In case 1, the patient was a 43-year-old man who presented with diarrhea and fever. Abdominal ultrasonography showed a sessile polypoid lesion in the body of the gallbladder that grew over 2 months. Gallbladder carcinoma was suspected and a cholecystectomy was performed. Examination of an intraoperative frozen specimen of the elevated lesion in the body of the gallbladder suggested a gallbladder carcinoma invading the subserosal layer. A bile duct resection and regional lymph node dissection were performed. However, the postoperative permanent sections revealed heterotopic gastric mucosa in the gallbladder. Case 2 was an 80-year-old man. Screening abdominal ultrasonography revealed a sessile polypoid lesion in the gallbladder. This lesion was correctly diagnosed as heterotopic gastric mucosa in the gallbladder by the intraoperative frozen examination. The pertinent literature on this topic is reviewed.

Heterotopic Gastric Mucosa in the Umbilicus

Heterotopia refers to the finding of normal tissue in foreign sites, entirely separate from the main organ. Heterotopic gastric mucosa has been observed throughout the alimentary tract, everywhere from the oral cavity to the rectum. However, occurrences in the umbilicus are an extremely rare and peculiar phenomena. We report the case of heterotopic gastric mucosa in the umbilicus.

Heterotopic Gastric Mucosa in the Cystic Duct

Heterotopic gastric mucosa in the gallbladder is rare (with about 100 reported cases), and its occurrence is even rarer in the biliary ductal system.The authors report a pediatric case of heterotopic gastric mucosa in the cystic duct associated with cholelitiasis.

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Recurrent Intussusception and Gastrointestinal Bleeding Secondary to Gastric Heterotopia of the Small Intestine

Mucosa gástrica heterotópica en el esófago proximal. Una causa desconocida de disfagia

Heterotopic gastric mucosa in the proximal third of the esophagus is an embryological lesion that has been described in between 1.1% and 10% of gastroscopies. Although most of these lesions are asymptomatic, they can sometimes be accompanied by upper esophageal symptoms due to acid secretion. We present a case of heterotopic gastric mucosa in the proximal third of the esophagus with dysphagia. pH-metry demonstrated acid secretion by these lesions, which was resolved by treatment with proton pump inhibitors.

Heterotopic gastric mucosa of the oral cavity: a rare entity

Objective: Heterotopic gastric mucosa found within the oral cavity has been reported as a rare occurrence with less than 30 cases in the English literature. We propose that this entity may not be as rare as originally described. Method: Five cases of heterotopic gastric mucosa in the oral cavity were collected from three institutions. Results: Five new cases of heterotopic gastric mucosa in the oral cavity were confirmed. Conclusions: Heterotopic gastric mucosa of the oral cavity may not be as rare as originally thought.

A CASE OF HETEROTOPIC GASTRIC MUCOSA IN THE GALLBLADDER

We report a case of heterotopic gastric mucosa in the gallbladder. The patient was a 69-year-old woman who visited another clinic because of nausea. Abdominal ultrasonography revealed a high-echoic polypoid lesion and CT revealed an enhanced mass at the neck of the gallbladder. The patient was referred to the hospital for further examination. Drip infusion cholangiography showed a filling defect 10mm in size at the neck of ballbladder. Since a possibility possibility of malignant tumor could not be ruled out, a cholecystestomy was performed and no malignant findings were found by intraoperative frozen pathological examination. The polypoid lesion was diagnosed as heterotopic gastric mucosa which consisted of gastric fundic glands and pyloric glands, and was located at the mucosa extending to muscular layer of the gallbladder by postoperative pathological examination of the fixed section. Heterotopic gastric mucosa of the gallbladder is rare. This case is tenth report in the Japanease literature. We report this case here with a review of the literature.