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Gastric inlet patch containing submucosally infiltrating adenocarcinoma
C Berkelhammer1, M Bhagavan, A Templeton
1Section of Gastroenterology, Christ Hospital and Medical Center, Oak Lawn, IL 60453, USA.
Journal of Clinical Gastroenterology
|February 6, 1998
Summary
A rare 7 cm gastric heterotopia in the proximal esophagus presented with adenocarcinoma. This finding highlights the need to consider malignancy in patients with esophageal strictures and ectopic gastric mucosa, even without Helicobacter pylori infection.
Area of Science:
- Gastroenterology
- Pathology
- Surgical Oncology
Background:
- Ectopic gastric mucosa, also known as a gastric inlet patch, is a congenital anomaly where gastric tissue is found outside the stomach, typically in the upper esophagus.
- While often asymptomatic, gastric heterotopia can be associated with various complications, including inflammation, ulceration, and, rarely, malignancy.
- The presence of Helicobacter pylori infection is a known risk factor for gastric pathologies, but its role in malignancies arising from ectopic gastric mucosa is less understood.
Observation:
- A patient presented with a 7 cm circumferential segment of ectopic gastric mucosa in the proximal esophagus.
- This gastric heterotopia featured benign rugal folds and a mid-portion stricture.
- Histopathological examination revealed normal antral-type gastric mucosa but demonstrated submucosally infiltrating adenocarcinoma within the stricture.
Findings:
- The adenocarcinoma infiltrating the ectopic gastric mucosa was found despite the absence of Helicobacter pylori infection, confirmed by both biopsy and serologic screening.
- The tumor's submucosal infiltration indicates a potentially aggressive presentation.
- The unusual length and location of the gastric heterotopia may have contributed to the development of the malignancy.
Implications:
- Malignancy, specifically submucosally infiltrating adenocarcinoma, must be considered in the differential diagnosis for patients presenting with strictures in ectopic gastric mucosa within the proximal esophagus.
- The occurrence of adenocarcinoma in this context, independent of Helicobacter pylori infection, underscores the intrinsic oncogenic potential of gastric heterotopia.
- This case emphasizes the importance of thorough endoscopic evaluation and biopsy in patients with symptomatic gastric inlet patches, particularly those with strictures, to ensure timely diagnosis and management of potential malignancies.