Intragastric Ectopic Liver

Area of Science:

• Gastroenterology
• Pathology
• Developmental Biology

Background:

• Ectopic liver (EL) is a rare congenital anomaly where liver tissue exists outside the native liver without vascular or biliary connections.
• While commonly found in the gallbladder, gastric EL is exceptionally rare, with few documented cases.
• Preoperative diagnosis of EL is challenging due to its rarity, small size, and asymptomatic nature.

Purpose of the Study:

• To report the first case of antral ectopic liver diagnosed preoperatively using endoscopic ultrasound (EUS)-guided biopsy.
• To emphasize the importance of considering EL in the differential diagnosis of gastric submucosal lesions.
• To highlight the diagnostic utility of EUS-guided fine needle biopsy in identifying ectopic liver tissue.

Main Methods:

• A 49-year-old male with dyspepsia underwent gastroscopy, revealing an antral submucosal lesion.
• Endoscopic ultrasound (EUS) characterized the lesion as a well-defined, hypoechoic, heterogeneous mass.
• EUS-guided fine needle biopsy (FNB) was performed, followed by histopathological examination with special stains.

Main Results:

• Histopathology confirmed ectopic liver tissue, showing normal hepatocyte plates without abnormal inclusions or hemosiderin deposits.
• The lesion involved the mucosa, muscularis mucosa, and submucosa, with no evidence of malignancy.
• This represents the first reported case of gastric ectopic liver in the antrum diagnosed preoperatively.

Conclusions:

• Ectopic liver should be considered in the differential diagnosis of gastric submucosal lesions.
• Histological confirmation is crucial to rule out malignancy, as hepatocellular carcinoma can develop in ectopic liver tissue.
• EUS-guided biopsy is an effective tool for the preoperative diagnosis of gastric ectopic liver.