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Fujiwara S, Nishimura R, Koyamada N. Intussusception of Heterotopic Gastric Mucosa in the Transverse Colon: A Rare Cause of Perforation and Bleeding. Cureus 2024; 16:e56142. [PMID: 38618424 PMCID: PMC11015529 DOI: 10.7759/cureus.56142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Heterotopic gastric mucosa in the colorectal region is a rare condition and can be found throughout the gastrointestinal tract. Intussusception in adults is mostly associated with adenocarcinoma and requires prompt surgical intervention, especially in cases of intestinal perforation. Our case report demonstrates a cecal perforation caused by the intussusception of heterotopic gastric mucosa within the transverse colon. The patient presented with substantial hematochezia. Despite the challenges of diagnosing this condition preoperatively and in the ICU, accurate pathologic evaluation is important. The consideration of a heterotopic gastric mucosa is crucial in cases of persistent hematochezia, especially in cases of intussusception. The postoperative course of the patient was characterized by hematochezia, which improved with proton pump inhibitors. The consideration of the possibility of heterotopic gastric mucosa may be a guide to appropriate surgical management and optimization of patient outcomes.
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Affiliation(s)
- Sho Fujiwara
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
| | - Ryuichi Nishimura
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
| | - Nozomi Koyamada
- Department of Surgery, Iwate Prefectural Chubu Hospital, Kitakami, JPN
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Heterotopic Pancreatic Tissue in the Gallbladder: a Report of a Very Rare Case. J Gastrointest Cancer 2021; 52:1175-1179. [PMID: 34263429 DOI: 10.1007/s12029-021-00663-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
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Thinking Outside the Box: Visualization of an Ectopic Stomach via Surgically Advanced Endoscopy at Site of Intussusception. ACG Case Rep J 2019; 6:e00236. [PMID: 31832463 PMCID: PMC6855554 DOI: 10.14309/crj.0000000000000236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/29/2019] [Indexed: 12/18/2022] Open
Abstract
We present a case of an ectopic stomach visualized intraoperatively at the site of intestinal intussusception via surgeon-assisted advancement of the endoscope. Heterotopic gastric mucosa, also known as an ectopic stomach, refers to the discovery of gastric tissues in an organ or tissue distinct from, and without vascular or anatomical continuity with, the main body of the normal stomach. In our case, an 18-year-old woman presented to the emergency department with jejunal intussusception. During emergency laparotomy, a large pedunculated mass was visualized and later confirmed histopathologically to be an ectopic stomach.
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Kantor M, Eiseler S, Schiller A, Hughes S, Liu X, Lai J. Pancreatic and gastric heterotopic tissue presenting as a symptomatic gallbladder mass: A case report and literature review. Clin Res Hepatol Gastroenterol 2018; 42:e72-e76. [PMID: 29625925 DOI: 10.1016/j.clinre.2018.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 02/04/2023]
Abstract
Pancreatic and gastric heterotopia is an uncommon congenital anomaly in which gastric and/or pancreatic tissue is found outside of its anatomic location. In the majority of patients, lesions are found incidentally because they tend to be asymptomatic. However, lesions may become symptomatic when inflammation, obstruction, and bleeding occurs. Depending on tissue size and location they can harvest a landscape of nonspecific symptoms, causing a delay in diagnosis. Heterotopic tissue of either gastric or pancreatic origin have been reported in literature, however the presence of combined gastric and pancreatic heterotopic tissue is exceedingly rare. We report a case of an 18-year-old female with polypoid gastric and pancreatic heterotopia and focal intestinal metaplasia of the gallbladder with clinical findings of acute cholecystitis. In this literature review, we synthesize the clinical significance, histopathological features, diagnosis and management of pancreatic and gastric heterotopic tissue.
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Affiliation(s)
- M Kantor
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States.
| | - S Eiseler
- Department of Internal Medicine, Kendall Regional Medical Center, 11750, Bird road, 33175 Miami, FL, United States
| | - A Schiller
- Department of Pathology, Kendall Regional Medical Center, Miami, FL, United States
| | - S Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - X Liu
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
| | - J Lai
- Department of Pathology, University of Florida College of Medicine, Gainesville, FL, United States
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Beeskow AB, Meyer HJ, Schierle K, Surov A. Heterotopic gastric mucosa in gallbladder-A rare differential diagnosis to gallbladder masses: A systematic review. Medicine (Baltimore) 2018; 97:e0058. [PMID: 29517663 PMCID: PMC5882432 DOI: 10.1097/md.0000000000010058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heterotopic gastric tissue can be found in the entire gastrointestinal tract. It is usually located in the upper intestine. Rarely, it can be found in the gallbladder. This study describes several clinically, imaging features as well as histopathology findings of heterotopic gastric tissue in gallbladder (HGM). METHODS The radiologic database of 1 tertiary university hospital was retrospectively screened for HGM. Additionally, a systemic review of the Medline database was conducted to identify previously published cases reports. In all cases clinical, imaging as well as histopathology features were retrieved from the papers. RESULTS In our databases, 1 patient with HGM was identified. Additionally, the systemic review yielded 32 suitable papers with 34 patients. Clinically, most of the patients suffered from abdominal discomfort. Most of the lesions were located in the lower gallbladder, especially (n = 14, 40%) in the gallbladder neck. On sonography, in 20.7% a broad-based mass was described. In 10.3% a sessile polyp was identified. In 5 cases, the mass was characterized as hyperechoic (55.5%), as isoechoic in 3 (33.3%) cases, and hypoechoic in 1 (11.1%). On computed tomography (CT), the lesions were most frequently hyperdense and all of them showed a slightly enhancement after application of contrast medium. On histopathology, most cases revealed heterotopic gastric mucosa of body-fundic type (60%) with chief and parietal cells, followed by pyloric type glands (20%). Every patient was treated with cholecystectomy and all had an uneventful recovery. CONCLUSION HGM is a rare disorder with several differential diagnoses. Typically features were described to identify HGM in clinical routine and rule out malignant diseases like gallbladder carcinoma.
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Affiliation(s)
| | | | - Katrin Schierle
- Department of Pathology, University Hospital Leipzig, Leipzig, Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology
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6
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Qiao WG, Zhang LZ, Zhi FC. Tumor-like heterotopic gastric mucosa discovered by wireless capsule endoscopy. J Dig Dis 2017; 18:543-544. [PMID: 28296263 DOI: 10.1111/1751-2980.12464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Wei Guang Qiao
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lan Zhi Zhang
- Department of Pathology, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Fa Chao Zhi
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Institute of Gastroenterology of Guangdong Province, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Chung CS, Lin CK, Liang CC, Hsu WF, Lee TH. Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch. Dis Esophagus 2015; 28:666-72. [PMID: 25059461 DOI: 10.1111/dote.12252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Foci of heterotopic gastric mucosa have been identified at different sites in the human body and the most common location is the proximal esophagus which is referred to as cervical inlet patch (CIP). The true prevalence of CIP varies and it is usually incidental findings during endoscopy. Because CIP is always asymptomatic, it was believed to be of little clinical relevance. However, emerging studies have described the acid-secreting characteristics of heterotopic gastric mucosa and associations of CIP with gastroesophageal reflux disease (GERD). In addition, complications such as stricture, fistula, infection, mucosal hyperplasia, and malignant transformation have been reported. In this study, we investigated the prevalence of CIP, its associations with clinical manifestations, and the effect of intentional screening upper esophagus by magnifying endoscopy-narrow-band imaging (ME-NBI) system. Consecutive healthy adults who underwent panendoscopy were separated into two groups. Patients in group I (n = 471) were examined by an endoscopist who intended to find CIPs by ME-NBI. Patients in group II (n = 428) were examined by two endoscopists who were unaware of the study and performed white-light imaging endoscopy. Participants provided questionnaires on GERD-related symptoms. Higher CIP prevalence (11.7% vs. 1.9%, P < 0.0001) and longer duration of esophageal examination (mean ± standard deviation, 17.50 ± 12.40 vs. 15.24 ± 10.78 seconds, P = 0.004) were noted in group I than in group II. Analyzing group I patients revealed the higher prevalences of reflux symptoms (32.7% vs. 18.3%, P = 0.013) and erosive esophagitis (43.6% vs. 25.5%, P = 0.005) in patients with CIP than in those without. CIP was not associated with globus or dysphagia symptoms. More small CIPs (< 5 mm) were detected by ME-NBI than by white-light imaging (85.3% vs. 41.4%, P = 0.001). In conclusion, CIP prevalence was not low under intentional ME-NBI examination of the upper esophagus. The clinical relevance of CIP and its association with GERD require further investigation.
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Affiliation(s)
- C-S Chung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - C-K Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - C-C Liang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - W-F Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - T-H Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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8
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Zhou C, Kirtane T, Tsai TH, Lee HC, Adler DC, Schmitt JM, Huang Q, Fujimoto JG, Mashimo H. Cervical inlet patch-optical coherence tomography imaging and clinical significance. World J Gastroenterol 2012; 18:2502-10. [PMID: 22654447 PMCID: PMC3360448 DOI: 10.3748/wjg.v18.i20.2502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 01/09/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To demonstrate the feasibility of optical coherence tomography (OCT) imaging in differentiating cervical inlet patch (CIP) from normal esophagus, Barrett’s esophagus (BE), normal stomach and duodenum.
METHODS: This study was conducted at the Veterans Affairs Boston Healthcare System (VABHS). Patients undergoing standard esophagogastroduodenoscopy at VABHS, including one patient with CIP, one representative patient with BE and three representative normal subjects were included. White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system. The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal (GI) tract. Standard hematoxylin and eosin (H and E) histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data.
RESULTS: CIP was observed from a 68-year old male with gastroesophageal reflux disease. The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy. OCT imaging over the CIP region showed columnar epithelium structure, which clearly contrasted the squamous epithelium structure from adjacent normal esophagus. 3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus, BE, normal stomach, and normal duodenum bulb. Microstructures, such as squamous epithelium, lamina propria, muscularis mucosa, muscularis propria, esophageal glands, Barrett’s glands, gastric mucosa, gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology. These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time.
CONCLUSION: We demonstrate in situ evaluation of CIP microstructures using 3D-OCT, which may be a useful tool for future diagnosis and follow-up of patients with CIP.
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9
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Kim HS, Kim JH, Yoon SO. Heterotopic gastric mucosa with focal intestinal metaplasia and squamous epithelium in the rectum. Dig Endosc 2012; 24:46-8. [PMID: 22211412 DOI: 10.1111/j.1443-1661.2011.01160.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heterotopic gastric mucosa has been described in all levels of the gastrointestinal tract. However, gastric heterotopia of the rectum is a rare finding. It is usually reported along with polyp located in the rectum between 5 and 8 cm from the anal verge. The most common symptom is painless rectal bleeding, and non-specific gastrointestinal symptoms may also be presented. We report an incidentally found case of a 46-year-old man without any gastrointestinal symptoms. The pathology showed gastric mucosa and squamous epithelium and focal intestinal metaplasia. This finding could be a clue as to the origins of the heterotopic gastric mucosa. Although there are no guidelines for treatment or the follow-up period, regular endoscopic surveillance is necessary for gastric cancer screening.
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Affiliation(s)
- Hee Sun Kim
- Health Promotion Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Bulus H, Yildiz M, Alimogullari M, Şximxşek G, Köklü S, Koçak E. Gastric Heterotopia within the Gallbladder Wall in a Patient with Chronic Cholecystitis. Am Surg 2012. [DOI: 10.1177/000313481207800132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hakan Bulus
- Kecioren Training and Research Hospital Ankara, Turkey
| | | | | | | | | | - Erdem Koçak
- Ankara Education and Research Hospital Ankara, Turkey
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11
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Daher P, Francis E, Raffoul L, Riachy E. Ectopic gastric mucosa in the cervical esophagus presenting as a recurrent neck abscess: a case report. J Pediatr Surg 2010; 45:e15-7. [PMID: 20620294 DOI: 10.1016/j.jpedsurg.2010.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 03/16/2010] [Accepted: 03/17/2010] [Indexed: 12/13/2022]
Abstract
We report a unique case of ectopic gastric mucosa (EGM) in the cervical esophagus. The patient presented with a recurrent cervical abscess communicating through a fistula with the EGM. Surgical treatment consisted of complete excision. The postoperative course was complicated by a breach in the hypopharynx, which was treated conservatively, and a stenosis of the esophagus requiring balloon dilation.
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Affiliation(s)
- Paul Daher
- Department of Pediatric Surgery, Hotel Dieu de France Hospital, PO Box: 16- 6830, Beirut, Lebanon
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12
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Orizio P, Villanacci V, Bassotti G, Falchetti D, Torri F, Ekema G. Heterotopic gastric mucosa in the cystic duct. Int J Surg Pathol 2009; 19:364-5. [PMID: 19448251 DOI: 10.1177/1066896909337717] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
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.
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Affiliation(s)
- Paolo Orizio
- Department of Pediatric Surgery, University of Brescia, Brescia, Italy
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13
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Triki E, Brigand C, Meyer C. [Heterotopic gastric mucosa in the gallbladder]. JOURNAL DE CHIRURGIE 2008; 145:376-377. [PMID: 18955931 DOI: 10.1016/s0021-7697(08)74320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- E Triki
- Service de chirurgie générale et digestive, pôle des pathologies digestives, hépatiques et de la transplantation, CHU de Strasbourg-Hautepierre - Strasbourg
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Popkharitov AI, Gulubova MV, Dandov AD, Sivrev DP. Heterotopic gastrointestinal cyst mimicking chronic cholecystitis: a case report. J Med Case Rep 2008; 2:173. [PMID: 18498655 PMCID: PMC2408929 DOI: 10.1186/1752-1947-2-173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 05/22/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Heterotopic 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 PRESENTATION A 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. CONCLUSION The 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.
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Affiliation(s)
- Angel I Popkharitov
- Department of Surgery, Medical Faculty, Thracian University, University Hospital, Stara Zagora, Bulgaria.
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15
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Verbo A, Manno A, Mattana C, Coco C, Sermoneta D, Vecchio FM, Pedretti G, Petito L, Rizzo G, Picciocchi A. Peptic ulcer in gastric heterotopia of the gallbladder without evidence of Helicobacter pylori infection. Dig Dis Sci 2007; 52:2201-3. [PMID: 17464563 DOI: 10.1007/s10620-006-9152-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Accepted: 11/08/2005] [Indexed: 12/09/2022]
Affiliation(s)
- Alessandro Verbo
- Department of Surgical Sciences, Catholic University of the Sacred Heart, Rome, Italy
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Brevet M, Brehant O, Dumont F, Regimbeau JM, Dupas JL, Chatelain D. [Adenomatous polyposis of the gallbladder and Gardner's syndrome. A rare association]. ACTA ACUST UNITED AC 2007; 31:425-7. [PMID: 17483782 DOI: 10.1016/s0399-8320(07)89404-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report one case of adenomatous polyposis of the gallbladder in a 57 year-old woman with Gardner's syndrome presenting with cholangitis. On gross examination the gallbladder contained two calculi and numerous flat or polypoid adenomas less than 1 cm in size. On microscopic examination, the adenomas showed low and high grade intraepithelial neoplasia. Only 10 cases of gallbladder adenomas have been reported in the literature in patients presenting with familial adenomatous polyposis (FAP). Cholecystectomy is usually performed for cholecystitis or cholangitis. These adenomatous gallbladder lesions are discovered late, often when the patient is older than 40. Pathogenesis of gallbladder adenomas is still unclear. It is difficult to assess the risk of malignancy: only 6 cases of gallbladder adenocarcinomas have been reported in patients with FAP.
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Affiliation(s)
- Marie Brevet
- Service d'Anatomie Pathologique, CHU Amiens, Place Victor Pauchet, Amiens, France.
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17
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Azar C, Jamali F, Tamim H, Abdul-Baki H, Soweid A. Prevalence of endoscopically identified heterotopic gastric mucosa in the proximal esophagus: endoscopist dependent? J Clin Gastroenterol 2007; 41:468-71. [PMID: 17450028 DOI: 10.1097/01.mcg.0000225519.59030.8d] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
GOALS The aim of this study is to determine the prevalence of heterotopic gastric mucosa in the proximal esophagus (HGMPE) and whether thorough endoscopic search may influence such prevalence. BACKGROUND Heterotopic gastric mucosa in the esophagus (sometimes known as inlet patch) refers to a discrete area of gastric mucosa, with a spherical or ellipsoid configuration, that is typically located in the proximal esophagus. The prevalence of endoscopically diagnosed HGMPE varies from 0.1% to 10%. Endoscopic detection may be difficult as HGMPE is often located at or just below the upper esophageal sphincter. It might be associated with severe complications such as bleeding, perforation, fistula, and stricture formation, in addition to the development of adenocarcinoma. STUDY During a 2-year period, 455 consecutive patients with various gastrointestinal complaints underwent esophagogastroduodenoscopy by a single endoscopist (group 1). This endoscopist paid special attention to detecting HGMPE by thoroughly examining the proximal esophagus upon withdrawal of the endoscope. During the same period of time, endoscopy reports of 472 patients who underwent esophagogastroduodenoscopy in the same hospital by 3 other endoscopists were retrospectively reviewed (group 2). These endoscopists were aware of the existence of the HGMPE and reported that the presence of HGMPE would be included as an endoscopic finding in their reports. RESULTS In the first group, HGMPE was identified in 12 out of 455 patients (2.6%). Whereas in the second group, only 2 out of 472 patients (0.4%) had reports identifying HGMPE (P<0.01). CONCLUSIONS Endoscopic detection of HGMPE is influenced by the endoscopist's thorough search of this entity, and thus, more time devoted to such a search may lead to higher detection rates.
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Affiliation(s)
- Cecilio Azar
- Department of Internal Medicine, American University of Beirut, Lebanon
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18
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Cöl C, Boran C, Turkeli V, Dinler K, Kordon O, Erkol H, Sengul N. Heterotopic gastric mucosa in gallbladder associated with kidney agenesis and congenital hip dysplasia. Acta Clin Belg 2007; 62:120-2. [PMID: 17547293 DOI: 10.1179/acb.2007.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Heterotopic gastric tissue in the gallbladder is an extremely rare condition. There is not any specific clinical or laboratory finding and correct diagnosis is not possible before histopathological examination. Preoperative diagnosis usually resembles a polypoid Lesion or a fixed gallstone. We reported a 34-year-old female patient with heterotopic gastric mucosa in the gallbladder associated with congenital hip dysplasia and kidney agenesis. Laparoscopic cholecystectomy was performed and histopathology of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundic type. Some cases of heterotopia in the gallbladder come from metaplasia, and may be one of the causes of gall bladder cancer. We discussed the clinical and histologic features of heterotopic gastric tissues and reviewed reported cases in the literature.
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Affiliation(s)
- C Cöl
- Department of General Surgery, Abant Izzet Baysal University Medical School, Turkey.
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19
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Mencin AA. Severe gastrointestinal bleeding. Clin Pediatr (Phila) 2006; 45:683-7. [PMID: 16928850 DOI: 10.1177/0009922806291027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ali A Mencin
- Division of Pediatric Gastroenterology, Morgan Stanley Children's Hospital of New York-Presbyterian, New York 10032, USA
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20
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Jimenez JC, Emil S, Steinmetz B, Romansky S, Weller M. Recurrent gastrointestinal tract bleeding secondary to jejunal gastric heterotopia. J Pediatr Surg 2005; 40:1654-7. [PMID: 16227002 DOI: 10.1016/j.jpedsurg.2005.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 4-year-old Latino boy with a history of malrotation, nonobstructing annular pancreas, and a Ladd procedure during infancy presented with recurrent severe gastrointestinal tract bleeding. Investigations revealed a large mass in the proximal small bowel. At laparotomy, the proximal jejunal segment containing the mass was resected. Pathological examinations revealed a large intraluminal polyp composed of ectopic gastric mucosa. The patient presented 10 months later with recurrent bleeding, and subsequent laparotomy demonstrated a newly acquired segment of jejunal polyposis not present at the first operation. The case is presented, along with a plan of patient surveillance and a review of the pertinent literature.
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Affiliation(s)
- Juan Carlos Jimenez
- Division of Pediatric Surgery, University of California, Irvine, Orange, CA 92868, USA
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Mukhopadhyay S, Landas SK. Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens. Arch Pathol Lab Med 2005; 129:386-90. [PMID: 15737036 DOI: 10.5858/2005-129-386-ppogda] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Dysplasia is thought to be a precursor of invasive gallbladder carcinoma, but it is unsettled whether dysplasia arises from other precursor lesions. OBJECTIVE To ascertain the presence and nature of precursors of dysplasia in the gallbladder. DESIGN Four hundred consecutive cholecystectomy specimens were processed and stained routinely for diagnosis. We retrospectively reviewed these cases to look for the presence of epithelial changes, including antral-type metaplasia, intestinal metaplasia, and dysplasia. RESULTS Antral-type metaplasia, intestinal metaplasia, and dysplasia were found in 238 (59.5%), 39 (9.8%), and 20 (5.0%) cases, respectively. The mean patient age was 47.7 years (range, 15-93 years). The mean ages for patients with antral-type metaplasia, intestinal metaplasia, and dysplasia were 49.4, 50.9, and 52.6 years, respectively. Statistically significant associations were found between antral-type metaplasia and intestinal metaplasia (P = .007, chi2 test) and between intestinal metaplasia and dysplasia (P < .001, chi2 test). CONCLUSION These associations, along with the age gradient from antral-type metaplasia to dysplasia, suggest a progression from antral-type metaplasia to dysplasia via intestinal metaplasia.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse 13210, USA
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Quispel R, Schwartz MP, Schipper ME, Samsom M. Heterotopic gastric tissue mimicking malignant biliary obstruction. Gastrointest Endosc 2005; 62:170-2. [PMID: 15990845 DOI: 10.1016/s0016-5107(05)00369-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Rutger Quispel
- Department of Gastroenterology, University Medical Center, 3508 GA Utrecht, The Netherlands
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Yoon AJ, Cowles RA, Stylianos S, O'Toole KM. Heterotopic gastric mucosa in the gallbladder: a rare cause of massive hemobilia. J Pediatr Gastroenterol Nutr 2005; 40:606-8. [PMID: 15861025 DOI: 10.1097/01.mpg.0000161040.73329.cb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Angela J Yoon
- Department of Pathology, Division of Surgical Pathology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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Wu XS, Akiyama Y, Igari T, Kawamura T, Hiranuma S, Shibata T, Tsuruta K, Koike M, Arii S, Yuasa Y. Expression of homeodomain protein CDX2 in gallbladder carcinomas. J Cancer Res Clin Oncol 2005; 131:271-8. [PMID: 15645288 DOI: 10.1007/s00432-004-0658-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2004] [Accepted: 11/09/2004] [Indexed: 12/16/2022]
Abstract
PURPOSE Caudal-related homeobox protein CDX2 plays an important role in the regulation of cell proliferation and differentiation of the intestinal epithelium. CDX2 is associated with intestinal metaplasia and carcinomas of the stomach, but the role of CDX2 in gallbladder carcinogenesis remains unknown. METHODS We analyzed the expression of CDX2 and intestinal apomucin MUC2 in gallbladder cancer cell lines at the mRNA level by the RT-PCR method. We also investigated the expression of CDX2 and MUC2 in 68 primary gallbladder carcinomas by the immunohistochemical staining method and compared the expression of CDX2 with the clinicopathological factors in the gallbladder carcinoma cases. RESULTS Expression of CDX2 and MUC2 was found in three of four gallbladder cancer cell lines at the mRNA level. In addition, we found that CDX2 was absent in the normal gallbladder epithelium, but the CDX2 protein was expressed in 25 of the 68 (36.8%) gallbladder carcinomas. Interestingly, in the tubular type gallbladder carcinomas, the frequency of CDX2 expression was much higher in the well-differentiated type than the moderately and poorly differentiated types, the difference being statistically significant (P<0.01). CDX2 expression showed a relationship with expression of MUC2 (P<0.04) in the gallbladder carcinomas. CDX2 was expressed in intestinal metaplasia and dysplasia, which are hypothesized to be premalignant conditions. CONCLUSION These results imply that CDX2 plays an important role in gallbladder carcinogenesis with intestinal differentiation.
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Affiliation(s)
- Xiang-Song Wu
- Department of Molecular Oncology, Graduate School of Medicine and Dentistry, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Francis EP, Sandahl L, Reed MJ, Miller OF. Cutaneous presentation of ectopic small bowel mucosa. J Am Acad Dermatol 2004; 51:476-7. [PMID: 15337999 DOI: 10.1016/j.jaad.2003.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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von Rahden BHA, Stein HJ, Becker K, Liebermann-Meffert D, Siewert JR. Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification. Am J Gastroenterol 2004; 99:543-51. [PMID: 15056100 DOI: 10.1111/j.1572-0241.2004.04082.x] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The prevalence of heterotopic gastric mucosa (HGM) in the cervical esophagus is frequently underestimated. Tiny microscopic foci have to be distinguished from a macroscopically visible patch, also called "inlet patch." Symptoms as well as morphologic changes associated with HGM are regarded as a result of the damaging effect of acid, produced by parietal cells in the mostly fundic type of HGM. We herein review the literature and propose a new clinicopathologic classification of esophageal HGM: Most of the carriers of esophageal HGM are asymptomatic (HGM I). Some individuals with HGM in the esophagus complain of dysphagia, odynophagia, or "extraesophageal manifestations" (hoarseness and coughing), without further morphologic findings (HGM II). Still fewer patients are symptomatic due to morphologic changes, i.e., esophageal strictures, webs, or esophagotracheal fistula (HGM III). Malignant transformation via dysplasia (intraepithelial neoplasia, HGM IV) to cervical esophageal adenocarcinoma (HGM V) is exceedingly rare (only 24 reported cases). In contrast to Barrett's esophagus, HGM should not be regarded as a precancerous lesion. Symptoms are more likely to occur in patients with inlet patch, whereas malignant transformation and adenocarcinogenesis can also occur in microscopic HGM foci. Asymptomatic HGM requires neither specific therapy nor endoscopic surveillance. Only in symptomatic cases treatment, i.e., dilatation for (benign) strictures or acid suppression for reflux symptoms, can be recommended. Patients with low-grade dysplasia in HGM might be candidates for surveillance strategies, whereas in cases of high-grade dysplasia and invasive adenocarcinoma oncological treatment strategies must be employed.
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