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

Abstract

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.

Expression of homeodomain protein CDX2 in gallbladder carcinomas

“…Intestinal metaplasia has been observed not only in the gastric mucosa but also in other organs including the gallbladder (Yuasa 2003;Xeropotamos et al 2001). This evidence led us to the idea that CDX2 may also play an important role in gallbladder carcinogenesis.…”

A mimicker of gallbladder carcinoma: cystic gastric heterotopia with intestinal metaplasia

“…Heterotopic tissue of various types in the gallbladder has been described in the literature, including gastric mucosa, pancreatic tissue, liver tissue, and others such as adrenal and thyroid tissue (2). Heterotopic gastric mucosa can be found anywhere in the alimentary tract from the tongue to the rectum, however, heterotopic gastric mucosa in the gallbladder is a rare entity (3,4). Heterotopic gastric mucosa, as well as intestinal metaplasia in the gallbladder, may be one of the causes of gallbladder cancer (3).…”

Pyloric gland type adenoma including intramucosal carcinoma focus of gallbladder

“…Its frequency is 66-84%. Frequency of intestinal MEC is 12-52% and they are frequently related with pyloric metaplasia (7). MEC are different from HGM.…”

“…In the literature, we determined 23 cases of HGM of (5). We also determined three other publications which 4 cases of HGM were analyzed in these reports (6)(7)(8). In these studies, the mean age and male/female ratio were 40.4 year (age interval; 16-78) and 2, respectively.…”

“…Fundic glands are not seen. (5)(6)(7)(8). MEC may be congenital or secondary to cholecystitis, cholelithiasis, or a tumoral growing (8).…”