Heterotopic Gastric and Esophageal Tissue in the Vermiform Appendix

Gastric heterotopia has been described throughout the gastrointestinal tract, from the oral cavity to the rectum, including the liver and the gallbladder [1][2][3][4][5][6]. We report a case of peptic ulcer in heterotopic gastric mucosa of the gallbladder in a 56-year-old man submitted to laparoscopic cholecistectomy for chronic calculous cholecystitis. From the first case of gastric heterotopia of the gallbladder, reported in 1934 [7], we reviewed 49 cases, including our report. In nine cases gallstones were also found and in four cases a peptic ulcer was identified [8]. The case reported describes the first association between peptic ulcer in gastric heterotopia of the gallbladder and gallstones. The presence of HP was investigated in order to evaluate its possible role in the ethiology of the ulceration. Case reportA 56-year-old man, with a history of Von Willebrand disease, was admitted to our hospital for a 2-year istory of episodic pain in the right quadrants of the abdomen, colicky and intermittent in character, irradiated posteriorly to the right shoulder. Physical examination revealed tenderness on palpation of the right upper quadrant of the abdomen and a positive Murphy's sign. Laboratory tests showed increased γ -glutamyltransferase (161 UI/L; normal range, 8-61 UI/L), prolonged activated protrombin time (42-60 sec; normal range, 20-36 sec), and white blood cell count in the normal range (7.63 × 10 9 /L; normal range, 4.10 × 10 9 -9.80 × 10 9 /L). Abdominal ultrasonography revealed marked parietal thickening of the gallbladder with multiple gallstones. Laparoscopic cholecystectomy was performed. The patient made an uneventful postoperative recovery and was discharged on the third postoperative day. On gross examination, the resected gallbladder contained multiple stones and an ulcerated lesion of approximately 1.5 cm in largest diameter localized in the body (Fig. 1). On hematoxylin-eosin (H&E) the lesion proved to be an area of heterotopic gastric mucosa of the fundic type (Figs. 2 and 3), without evidence of metaplastic or dysplasic changes. H&E and Giemsa stainings were carefully searched for the presence of HP, but no evidence of colonization was identified in the heterotopic mucosa. Discussion

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confidence: 99%

Peptic Ulcer in Gastric Heterotopia of the Gallbladder Without Evidence of Helicobacter pylori Infection

et al. 2007

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“…It was first described by Egyedi in 1934 7. Since then it has been reported in various organs and sites in the gastrointestinal tract, including the tongue,1oesophagus,2 epiglottis,3 small bowel,4 vermiform appendix,5rectum,3 6 and gall bladder 7-1724-34 A survey of the world literature revealed 45 reports, including the present cases, and interestingly none shared the broad spectrum of clinical and histological findings of our cases.…”

Section: Discussionmentioning

confidence: 46%

Heterotopic gastric mucosa together with intestinal metaplasia and moderate dysplasia in the gall bladder: report of two clinically unusual cases with literature review

Xeropotamos

Skopelitou

Batsis

et al. 2001

Gut

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We report the clinicopathological findings of two patients with ectopic gastric mucosa within the gall ladder. The first patient, a 78 year old man, was asymptomatic. He was admitted to hospital for a colon adenocarcinoma. Intraoperatively, a firm nodule was palpable in the gall bladder. Histological examination of the resected specimen revealed a body type gastric mucosa in the submucosa, adjacent to which were extensive pyloric gland and intestinal metaplasia with mild to moderate dysplasia. The remaining gall bladder mucosa demonstrated changes of chronic cholecystitis. The second patient was a 62 year old woman with symptoms of chronic cholecystitis. The preoperative diagnosis was consistent with this diagnosis with a "polyp" at the junction of the neck and cystic duct. Cholecystectomy was performed and the histological examination of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundus type. In the remaining mucosa, chronic cholecystitis was evident. To the best of our knowledge, this is the first report of a clinicopathological presentation of heterotopic gastric mucosa, pyloric gland type, and intestinal metaplasia with dysplastic changes in the gall bladder. As heterotopic tissue may promote carcinogenesis of the gall bladder, close attention should be paid to any occurrence of such lesions in this anatomical region.

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“…Colorectal GH has been reported in all age groups, ranging from the first day after birth to as old as 69 years . In the current study, most of our patients were adults (median age = 54 years).…”

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confidence: 53%

“…To our knowledge, the current study (with 33 examples) is the largest series addressing GH involving the lower GI tract. Most of the previously reported examples of GH of distal bowel have appeared as single case reports from various regions of the world …”

Section: Discussionmentioning

confidence: 99%

“…Most of the previously reported examples of GH of distal bowel have appeared as single case reports from various regions of the world. 2,12,[20][21][22][23][24][25][26][27][28] Colorectal GH has been reported in all age groups, ranging from the first day after birth to as old as 69 years. 2,[20][21][22][23][24][25][26][27] In the current study, most of our patients were adults (median age = 54 years).…”

Section: Discussionmentioning

confidence: 99%

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