Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers

Endoscopic submucosal dissection combined surgery for the treatment of ectopic gastric mucosa and ectopic pancreas in muscularis propria and serosal layer of the stomach: A rare case report and review of the literature

RATIONALE

Ectopic gastric mucosa (EGM) and ectopic pancreas (EP) in the stomach is a rare congenital anomaly. No research on the coexistence of EGM and EP in the stomach has been found. However, several studies have shown canceration of EGM outside the stomach and EP. Active surgical treatment may be necessary. This paper introduces a new case of ectopic gastric mucosa and ectopic pancreas in muscularis propria and serosal layer of the stomach and which were ultimately removed by endoscopic submucosal dissection combined surgery.

PATIENT CONCERNS

The patient was a 25-year-old male. Upper gastrointestinal endoscopy showed a subepithelial lesion in gastric antrum.

DIAGNOSES

Postoperative pathology confirmed a diagnosis of EGM and EP.

INTERVENTIONS

Enhanced computed tomography scan and endoscopic ultrasonography showed a submucosal tumor. Then endoscopic submucosal dissection was performed, during which a lesion was observed on the anterior wall of the stomach near the pylorus. This lesion invades the muscularis propria of the stomach and the large lesions near the pylorus may lead to pyloric obstruction. Considering these situations comprehensively, the patient ultimately underwent surgical resection of gastric lesion and partial gastrectomy.

OUTCOMES

After 3 months of follow-up, the patient was recovering well and no recurrence of the lesion was found so far.

LESSONS

EGM along with EP in the stomach is a rare condition. Due to its rarity, there was a lack of sufficient data support for its treatment and prognosis. Due to the EGM and EP may become cancerous, clinical attention should be paid to it. In this study, we present a new case report of EGM along with EP in the stomach and review the existing literature to explore treatment options for it.

Risk Factors for Symptoms in Patients With Heterotopic Gastric Mucosa in the Upper Esophagus

Goal: This study is aimed at comparing the clinical characteristics and histological types of symptomatic and asymptomatic patients with heterotopic gastric mucosa in the upper esophagus (HGMUE) and exploring the factors influencing the occurrence and severity of laryngopharyngeal reflux (LPR) symptoms in these patients. Background: HGMUE is a potential cause of LPR symptoms. Study: This retrospective analysis evaluated 70 patients with HGMUE using a detailed questionnaire. Clinical, histological, high-resolution manometry, and 24-h pH impedance monitoring data were compared between symptomatic (n = 49) and asymptomatic (n = 21) patients. Results: The diameter of HGMUE was significantly larger in the symptomatic group (p < 0.05), and the incidence of LPR symptoms increased with larger diameter grades; male patients were more likely to have LPR symptoms. The incidence of LPR symptoms varied significantly across histological classifications, being highest in patients with the fundic type (χ 2 = 6.64, p < 0.05). Binary logistic regression analysis identified sex and histological type as risk factors for LPR symptoms, with odds ratios of 8.996 (95% confidence interval (CI): 1.350-59.962) and 8.493 (95% CI: 1.486-48.522), respectively. The mean nocturnal baseline impedance (MNBI) in the upper esophagus was significantly lower in the symptomatic group (1676.82 ± 739.09 Ω vs. 2441.01 ± 604.11 Ω; p < 0.05). Clinical and demographic characteristics did not significantly affect the severity of LPR symptoms. Conclusion: The diameter, histological type, and sex of patients are risk factors for the occurrence of LPR symptoms in patients with HGMUE. More attention should be paid to patients with these factors. The MNBI is an effective indicator of the symptoms and treatment.

Gastric and Pancreatic Ectopic Mucosa in the Gallbladder: A Unique Mimicker of Polypoid Lesions

A 46-year-old woman with upper quadrant pain and nausea, diagnosed with cholelithiasis, underwent cholecystectomy. A 0.7 cm polypoid lesion in the gallbladder showed mostly heterotopic gastric mucosa with antral and oxyntic glands and foveolar epithelium. A focal area of the heterotopic pancreas, comprising acini and ducts with positive trypsin staining but no islet cells, was found. Additional findings included minimal inflammation, an adenomyoma on the opposite wall, and black gallstones, leading to a diagnosis of a heterotopic polyp. This case underscores the importance of thorough histopathological examination in diagnosing rare heterotopic tissues in the gallbladder, preventing misdiagnosis with malignant entities.

Nonpolypous Hamartomas of the Gastrointestinal Tract: An Updated Review on Classification, Denominations, and Clinical Management

PURPOSE

To perform the first systematic report about histological subtypes of nonpolypous hamartomas of the gastrointestinal (GI) tract, from esophagus to anal canal.

DESIGN

From over 19,000 studies about hamartomas, most of them published as case series or case presentations, we have selected the most representative ones for the GI tract, excluding polyposis syndromes. To have a whole picture of these hamartomas, all of the data were combined with the personal experience of the authors who are GI pathologists.

RESULTS

The examined articles showed predominance of vascular and combined vascular and mesenchymal hamartomas. Arteriovenous hamartomas or Brunner gland hamartomas are mainly diagnosed in the small intestine, with preponderance for duodenum. Other malformations such cavernous hamartomas are more specific for the colorectal segments, whereas chondromatous hamartomas or those derived from the neural ectoderm were mostly reported in the esophagus. As newly recognized entities were admitted in the last years, misdiagnosis is frequent, and the best therapeutic approach is far to be known.

CONCLUSION

Even rare, hamartomas of the GI tract need to be differentiated from tumors and familial polyposis syndromes. Knowing their proper denominations and possible complications is valuable for gastroenterologists, pathologists, and surgeons, to be aware in the differential diagnosis.