Heterotopic Gastric Tissue Research Articles

Giant Heterotopic Gastric Mucosa Presenting as a Polypoid Mass

Purpose: Heterotopic gastric tissue in the duodenal bulb (HGTD) is a rare congenital lesion. We present a patient with giant HGTD presenting as a polypoid mass. A 22 year old female with Type II diabetes mellitus presented with epigastric pain and nausea for 2 months. The patient underwent an esophagogastroduodenoscopy (EGD) which showed a 4 cm polypoid laterally spreading mass, occupying one third of the duodenal lumen over the posterior and inferior walls, extending from the bulb to the second portion (Figure 1). Narrow band imaging findings (Figure 2) were suspicious for an adenoma; however, biopsies revealed gastric heterotopia with reactive gastropathy in small bowel mucosal tissue (Figure 3). She was managed conservatively. Heterotopic gastric tissue has been found throughout the alimentary tract. It is usually an incidental finding, but may present with symptoms such as diarrhea, dyspepsia, ulceration, or bleeding. HGTD may occur as a single polypoid mass between 1-2.5 cm in size or as multiple polyps from 3-10 mm in size. Endoscopic examination with biopsy remains the gold standard for diagnosis. Management is usually conservative unless symptoms due to mass effects are present.Figure: Polypoid mass, NBI.Figure: Gastric heterotopia with reactive gastropathy.Figure: Polypoid mass.

Examination of the aero-digestive tract during routine endoscopy

I read with interest the recent publication by Katsinelos et al. on examination of the laryngopharyngeal area during routine upper gastrointestinal (GI) endoscopy [ [1] Katsinelos P. Kountouras J. Chatzimavroudis G. et al. Should inspection of the laryngopharyngeal area be part of routine upper gastrointestinal endoscopy? A prospective study. Dig Liver Dis. 2009; 41: 283-288 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. Despite the overall low yield, they highlighted an important aspect of upper GI endoscopy examination that is commonly neglected. They also showed it can be done in most cases without causing additional discomfort to the patient. However, there is another area that deserves attention. The proximal portion of the esophagus, just beyond the upper esophageal sphincter is the other commonly neglected area. Abnormal or pathological findings are uncommon but may account for patients’ symptoms. Cervical inlet patch (CIP) is probably the most commonly encountered abnormality in this area with incidence ranging from 0.29 to 10% in endoscopic studies [ 2 Maconi G. Pace F. Vago L. Carsana L. Bargiggia S. Bianchi Porro G. Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch). Eur J Gastroenterol Hepatol. 2000; 12: 745-749 Crossref PubMed Scopus (82) Google Scholar , 3 Baudet J.S. Alarcón-Fernández O. Sánchez Del Río A. Aguirre-Jaime A. León-Gómez N. Heterotopic gastric mucosa: a significant clinical entity. Scand J Gastroenterol. 2006; 41: 1398-1404 Crossref PubMed Scopus (28) Google Scholar , 4 Borhan-Manesh F. Farnum J.B. Incidence of heterotopic gastric mucosa in the upper oesophagus. Gut. 1991; 32: 968-972 Crossref PubMed Scopus (128) Google Scholar ]. Similar to the Meckel's diverticulum, CIP contains heterotopic gastric mucosal tissue which can produce acid secretion. Although asymptomatic in most cases, patients with CIP have been shown to have more laryngopharyngeal reflux (LPR) symptoms [ [5] Akbayir N. Alkim C. Erdem L. et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol. 2004; 19: 891-896 Crossref PubMed Scopus (69) Google Scholar ]. Since reporting our own experience with CIP, I now routinely examine the proximal esophagus, especially in patients with LPR symptoms with reasonable yield of CIP detection [ [6] Chong V.H. Jalihal A. Cervical inlet patch: case series and literature review. South Med J. 2006; 99: 865-869 Crossref PubMed Scopus (20) Google Scholar ].

Gastric Choristoma of the Oropharynx

Heterotopic gastric mucosa tissue is also called gastric choristoma, and this type of lesion can be found anywhere in the alimentary tract. However, gastric choristoma in the pharynx is very rare; only 10 cases of pharyngeal gastric choristoma have been reported in the English medical literature. A 32-yr-old woman was referred to our institution for the evaluation of a large mass that originated from the posterior wall of the oropharynx. The mass did not cause any symptoms except for the occasional sensation of a foreign body. Gadolinium-enhanced T1 weighted imaging showed a 5 cm-sized mass with central enhancement and hypointense portions, yet the radiological diagnosis was not clear. Transoral mass excision was performed with using electrocautery for making the diagnosis and for treating the mass. The microscopic analysis revealed gastric choristoma.

Common characteristics of jejunal heterotopic gastric tissue in children: a case report with review of the literature

An 11-year-old boy underwent laparotomy for intermittent intussusceptions because of a polypoid lesion located in the proximal jejunum. The polypoid lesion was diagnosed as heterotopic gastric mucosa (HGM). Jejunal HGM is a very rare entity, and review of the literature revealed common characteristics in children with this pathologic condition. The usual presenting age is about 14 years, and the common clinical picture is intermittent intussusceptions. Jejunal HGM is usually polypoid and predominantly located within a few centimeters distal to ligament of Treitz. The aforementioned characteristics should suggest jejunal HGM be included in the differential diagnosis of jejunal polypoid lesions in children.

Heterotopic gastrointestinal cyst mimicking chronic cholecystitis: a case report

IntroductionHeterotopic gastric mucosa is described almost everywhere in the gastrointestinal tract, from the oral cavity to the rectum. The occurrence of heterotopic gastric tissue in the gallbladder is rare. A choristoma can be defined as a new growth developing from a displaced anlage not normally present in the anatomical site where it developed. We present an extremely uncommon case of a cyst (choristoma) attached to the gallbladder, which contained gastric and intestinal mucosa.Case presentationA 33-year-old woman was hospitalized with clinical symptoms of chronic cholecystitis. The laboratory findings were within the normal range. Abdominal ultrasonography revealed a thickened gallbladder wall and a stone in the cystic duct was suspected. In the course of laparoscopic cholecystectomy, a cyst was visualized in the vicinity of the duct and the gallbladder neck. Microscopic examination of the removed cyst revealed evidence of gastric, duodenal and small-intestinal mucosa. The immunohistochemical study revealed many endocrine cells, which were positive for several endocrine cell markers such as chromogranin, serotonin, gastrin and so on. It can be inferred that the observed cyst had arisen from the foregut early in the development of the gastrointestinal tract.ConclusionThe presence of endocrine cells together with epithelial cells supports the hypothesis that these had developed simultaneously, and that the endocrine cells had probably supported the development of the epithelial cells by the release of hormones and growth factors. To the best of the authors' knowledge, this report is the first to report a gastrointestinal cyst choristoma with endocrine cells in the region of the cystic duct and gallbladder.

Extraintestinal heterotopic gastric tissue simulating acute appendicitis

We describe the case of a 68 year old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revealed an enlarged lymph node-like mass of tissue near the appendix, in the ileocecal mesentery. This mass was removed and was found to be inflamed heterotopic gastric tissue. Although reports of heterotopic gastric tissue in the literature are common, we believe that this case represents the first report of inflamed heterotopic gastric tissue simulating appendicitis.

Heterotopic gastric tissue mimicking malignant biliary obstruction

Heterotopic gastric tissue can be found throughout the GI tract, from the oral cavity to the anus. Occasionally, it is found to occur in the biliary tract, usually in the gallbladder. To date, 6 reports about heterotopic gastric mucosa of the common bile duct (CBD) or of the common hepatic duct have been described. Diagnosis was established after surgery in all cases. We report a case in which EUS and intraductal US (IDUS) were used in the diagnostic workup.

Rare Mesenteric Location of Meckel's Diverticulum, A Forgotten Entity: A Case Study aboard USS Kitty Hawk

The traditional understanding of Meckel's diverticulum has always emphasized its antimesenteric location, ever since its original description in 1809. We report the finding of an acutely inflamed mass located on the mesenteric aspect of distal ileum, which was discovered during a celiotomy performed aboard a U.S. Navy aircraft carrier. Pathological features of this unusual mass, including focal submucosal abscess formation, proximity to the ileocecal valve, and heterotopic gastric tissue are all characteristic of inflammatory Meckel's diverticulum. The atypical intraoperative finding of a desmoplastic reaction associated with this lesion is discussed within the context of a pertinent differential diagnosis. In addition, both the pathological characteristics and the unusual location of this mass are the basis for a discussion that revisits a 50-year-old surgical controversy regarding Meckel's diverticulum.

Inverted Meckel's diverticulum as a source of chronic gastrointestinal blood loss

CASE REPORT A 60-year-old man came to his physician with fatigue, weakness, and dyspnea on exertion. He had a 3-year history of chronic gastrointestinal bleeding and a hematocrit of 17% at the time of initial evaluation. He received 4 units of packed red blood cells, and his hematocrit increased to 32%. Esophagogastroduodenoscopy and colonoscopy were unrevealing. On referral to our clinic, the patient’s hematocrit had fallen 7% despite oral iron therapy. Physical examination was unremarkable. Enteroclysis demonstrated a 6-cm tubular filling defect in

Heterotopic brain in the parapharyngeal space

There have been numerous reports of various types of heterotopic tissue in the head and neck. Heterotopic cartilage, gastric tissue, thyroid, and salivary gland in such various locations as tongue, gingiva, palate, nasopharynx, parapharyngeal space, and neck have been frequently reported, Heterotopic brain in the parapharyngeal space causing airway obstruction in the neonate has been rarely described. These benign masses are capable of expansion and because of their location, can lead to significant airway and feeding difficulties. We describe 3 cases of heterotopic brain tissue in the parapharyngeal space causing feeding difficulties and airway obstruction in the neonatal period. Two were initially misdiagnosed as lymphatic malformations. In the third, a nine month delay in diagnosis occurred. The diagnostic features of heterotopic brain in this location and some management suggestions in treating such a lesion are discussed.

Heterotopic Gastric Tissue in the Scrotum

A 2-year-old boy who underwent right inguinal herniotomy as a neonate presented with a right hydrocele. Exploration revealed a large hydrocele sac containing a creamy fluid with 2 interconnecting compartments and no patent processus vaginalis. The upper pouch was excised and the lower pouch was opened, according to Jaboulay’s operation. Histology of the sac revealed gastric heterotopia (see figure). Postoperatively a 99mtechnetium pertechnetate scan failed to demonstrate any residual gastric tissue. The patient presented 2 years later with recurrent hydrocele, which was aspirated (pH 7.34). Ten months later he is asymptomatic. DISCUSSION Heterotopia refers to the presence of tissues at sites where they are not normally found. Heterotopic gastric mucosa has been described throughout the length of the gastrointestinal tract, including the hepatobiliary system, and in the skin of the abdominal wall.’ To our knowledge we report the first case of heterotopic gastric mucosa in the scrotum. The embryonic foregut initially comprises a continuous endodermal tube encased in a thick stratum of mesoderm, which provides most of the mural and connective tissue framework of the foregut wall. In the region of the future stomach this mesodermal thickness forms a part of the primitive peritoneal cavity by clefting, cavitation and subsequent coalescence. During this process a portion of gastric mucosa, while remaining in the midline, may have been displaced into the primitive peritoneal cavity, and then may have migrated down with the testis into the scrotum. In contrast, ectopic splenic tissue has been noted only in the leR scrota1 compartment.z Our second hypothesis is that ectopic tissue developed from existing pluripotential cells in that region, which is supported by the fact that aberrant adrenal tissue has been described in the wall of the hernial sac and in the In conclusion, our case illustrates that heterotopia is not only of

Heterotopic Gastric Tissue in the Scrotum

A 2-year-old boy who underwent right inguinal herniotomy as a neonate presented with a right hydrocele. Exploration revealed a large hydrocele sac containing a creamy fluid with 2 interconnecting compartments and no patent processus vaginalis. The upper pouch was excised and the lower pouch was opened, according to Jaboulay’s operation. Histology of the sac revealed gastric heterotopia (see figure). Postoperatively a 99mtechnetium pertechnetate scan failed to demonstrate any residual gastric tissue. The patient presented 2 years later with recurrent hydrocele, which was aspirated (pH 7.34). Ten months later he is asymptomatic. DISCUSSION Heterotopia refers to the presence of tissues at sites where they are not normally found. Heterotopic gastric mucosa has been described throughout the length of the gastrointestinal tract, including the hepatobiliary system, and in the skin of the abdominal wall.’ To our knowledge we report the first case of heterotopic gastric mucosa in the scrotum. The embryonic foregut initially comprises a continuous endodermal tube encased in a thick stratum of mesoderm, which provides most of the mural and connective tissue framework of the foregut wall. In the region of the future stomach this mesodermal thickness forms a part of the primitive peritoneal cavity by clefting, cavitation and subsequent coalescence. During this process a portion of gastric mucosa, while remaining in the midline, may have been displaced into the primitive peritoneal cavity, and then may have migrated down with the testis into the scrotum. In contrast, ectopic splenic tissue has been noted only in the leR scrota1 compartment.z Our second hypothesis is that ectopic tissue developed from existing pluripotential cells in that region, which is supported by the fact that aberrant adrenal tissue has been described in the wall of the hernial sac and in the In conclusion, our case illustrates that heterotopia is not only of

Gastric heterotopia causing airway obstruction

Two infants are reported each with a mass of heterotopic gastric tissue in the hypopharynx causing airway obstruction. Endoscopic laser removal of the tumours proved a satisfactory method of treatment. Gastric heterotopia in the head and neck region is rare but should be considered as a cause of stridor in infants.

Heterotopic gastric tissue in the duodenum: a report of eight cases.

Eight patients with intraduodenal gastric heterotopic are described. Seven were under investigation for x-ray-negative dyspepsia, and one presented with repeated attacks of hematemesis. As all of these cases were diagnosed by the use of upper-gastrointestinal endoscopy and biopsy under direct vision, it is likely that more widespread use of these techniques will lead to an increase in the reported incidence of a condition previously thought to be rare.

Heterotopic gastric and esophageal tissue in the colon.

HETEROTOPIA, the development of tissues in sites other than those in which they are normally seen, is a phenomenon of great interest to pathologists and embryologists alike. It is, therefore, not surprising to find a fairly extensive literature on this subject which has been well reviewed in the account given by Willis.1In the paper presented here, however, a case will be described which, to our knowledge, appears to be the only one of its kind; it will clearly have to be taken into account in any attempted explanation of the phenomenon of heterotopia in the intestinal tract. The report concerns the occurrence of gastric and of esophageal mucosa in the terminal ileum and past the ileocecal valve in unmistakably colonic mucosa. Report of a Case A 24-year-old white woman, gravida 1, para 0, admitted to the hospital in early labor with ruptured membranes, and leaking gross quantities of

HETEROTOPIC GASTRIC AND ESOPHAGEAL TISSUE IN THE VERMIFORM APPENDIX.

HETEROTOPIC GASTRIC AND ESOPHAGEAL TISSUE IN THE VERMIFORM APPENDIX.

Meckel's Diverticulum—Two Cases Diagnosed Radiologically

Any portion of the vitelline duct may fail to become obliterated; persistence of the proximal portion constitutes Meckel's diverticulum. The sacarises from the antimesenteric border of the gut and varies greatly in shape, size and position: the average distance from the ileo-caecal valve is some 50 cm (Owen and Finney, 1949). It has a complete intestinal wall and its wide ostium allows easy entrance and exit of intestinal contents. Few Meckel's diverticula give rise to trouble: symptoms when they occur are due only to complications which are themselves generally secondary to further anatomical or physiological anomalies (Edwards, 1949). Thus, for example, attachment of the sac to the abdominal wall by the remainder of the vitelline duct or the presence of heterotopic gastric or pancreatic tissue may be responsible. A number of possible complications have been reported: 1. Inflammation, perforation or strangulation of the diverticulum. 2. Obstruction or strangulation of the intestine. 3. Intussusception. 4. Tumours, cysts and calculi, all of which are rare. 5. Ulceration, usually due to secreting heterotopic gastric tissue. Especially in children, the last complication gives rise to the most common symptom of rectal haemorrhage or melaena (Grossman, Fishback and Lovelace, 1950). Lower abdominal pain may be a feature, but is not invariably present. Radiology is, of course, valuable where a Meckel's diverticulum is responsible for acute abdominal disease (Frimann-Dahl, 1951), but in practice the pre-operative radiological diagnosis is only sought where the condition is suspected because of intestinal haemorrhage.

MECKEL'S DIVERTICULUM

The case reported in this paper is of interest not only because it appears to be unique but also because it emphasizes two aspects of Meckel's diverticulum which have received some attention but are not yet sufficiently appreciated or emphasized. These considerations are, first, that Meckel's diverticulum rather frequently contains heterotopic alimentary tissue, and second, that the diverticulum may manifest itself clinically by bleeding, especially if it contains heterotopic gastric tissue, although this is not the only cause of bleeding. An analysis of the reported cases of bleeding Meckel's diverticulum with a discussion of the more probable causes of the hemorrhage will be given subsequently. REPORT OF CASE1 History. —A boy, aged 16, American born, a high school student, had been in good health up to the onset of the illness to be described, with the exception of mild but persistent constipation associated with occasional vague, transitory pain in