On the existence and location of cardiac mucosa: an autopsy study in embryos, fetuses, and infants

Abstract

Background: The incidence of gastric cardiac adenocarcinoma has increased in the last decades. Gaining insight into the pathogenesis of this lesion is hampered by the limited knowledge of the origin and histology of cardiac mucosa (CM). Currently, the location, extent, and even the existence of CM are controversial. Aims: We studied the development of the gastro-oesophageal junction (GOJ) in embryos, fetuses, and infants to clarify if CM is a normal structure at birth and where it is located. Subjects: Twenty one autopsy cases were evaluated ranging in age from 13 weeks' gestational age (GA) to seven months. Methods: The distal oesophagus and proximal part of the stomach were embedded entirely. Serial sections were stained with haematoxylin-eosin and alcian blue/periodic acid-Schiff. The following parameters were measured: length of abdominal oesophagus; length of columnar lined oesophagus; length of CM; and distance from CM to angle of His. Results: CM was present in all evaluated sections. Its mean length varied throughout gestation. A maximum value was reached at a GA of 16 weeks (1.2 mm). After term delivery it was very short (0.3-0.6 mm). CM was proximal to, or straddled, the angle of His in all cases. During gestation, the mucin staining pattern of the CM was to a high degree similar to that of the developing pyloric mucosa. Conclusions: CM develops during pregnancy and is present at birth as a normal structure. If the angle of His is taken as a landmark for the GOJ, CM is located in the distal oesophagus.

On the origin of cardiac mucosa: A histological and immunohistoc-hemical study of cytokeratin expression patterns in the developing esophagogastric junction region and stomach

“…Immunohistochemistry for CK5,7,8,13,18,19, and 20 was performed. Antibody staining was then graded for location, intensity, and degree.…”

“…We have earlier done a histological study on mucosal development in the EGJ of embryos and fetuses [19] . In this study, CM was defined as a structure composed of columnar foveolar and surface epithelium overlying glandular structures containing no parietal cells.…”

Obesity and related risk factors in gastric cardia adenocarcinoma

“…Because the incidence and extent of the cardiac glands were linked to excessive gastroesophageal reflux, this led Chandrosoma et al [9] to speculate that cardiac glands may be an acquired change from esophageal squamous mucosa. However, cardiac glands were subsequently identified in most children, the newborn, and even in fetuses [10][11][12], suggesting that they are present from early in life, representing a functionally distinct, albeit small, anatomical region of the normal stomach.…”

Endoscopic findings of esophagogastric junction in children

“…Digestive Endoscopy © 2017 Japan Gastroenterological Endoscopy Society and infant cases, De Hertogh and colleagues reported that cardiac mucosa exists since 13 weeks gestational age in all samples and is present around the esophageal perimeter, has a mean length of 0.3-0.6 mm, and is located proximal to or at the EGJ if it is defined as the angle of His. 30 To avoid over-or underdiagnosis of endoscopically suspected BE, firm diagnosis criteria were established. Thus, the Montreal Global Consensus Document revised the definition of BE to involve not only intestinal-type metaplasia but also pure gastric cardia-type metaplasia as part of the spectrum of BE.…”