Colonic Adenocarcinoma Arising from Gastric Heterotopia: A Case Study

Abstract

Heterotopic gastric mucosa occurs in all areas of the gastrointestinal tract including the nasopharynx, tongue, esophagus, small intestine, colon, and rectum. Gastric heterotopia of the large bowel is infrequent, and most cases have been reported in the rectum. Review of the literature has revealed only eight cases involving the colon proximal to the rectum. Little is known of the natural history of gastric heterotopias, except that. It usually presents with gastrointestinal bleeding, though other serious complications such as bowel perforation, intussusceptions, and fistula formation, are possible. Further, it is unclear whether heterotopic gastric mucosa progresses to malignancy. Herein, we describe a case of adenocarcinoma of the transverse colon arising from gastric heterotopia. To the best of our knowledge, this is the first report of adenocarcinoma arising from heterotopic gastric mucosa in the colon.

The outlet patch: gastric heterotopia of the colorectum and anus

“…However, technetium‐99m pertechnetate scanning can show increased uptake in the heterotopic gastric mucosa . On microscopy, the heterotopic mucosa of the lower GI tract is most commonly oxyntic‐type (83%), followed by mixed oxyntic‐ and antral‐type mucosa (11%), antral‐type (5%) and cardiac‐type (2%) . A similar pattern was also reflected in our series, as oxyntic‐type mucosa was the most common (85%), followed by mixed oxyntic‐ and non‐oxyntic‐type mucosa in 12%.…”

“…This was also reflected in the current study, as GH was detected in the rectum in 79% (26 of 33) of cases, followed by the anus (12%; four of 33) and colon (9%; three of 33). To date, only 11 cases (including three in the present study) have been reported in which GH have been identified involving parts of colon proximal to the rectum . To our knowledge, the current study (with 33 examples) is the largest series addressing GH involving the lower GI tract.…”

“…Although the exact pathogenesis remains largely unresolved, several hypotheses have been put forward to explain the occurrence of heterotopic gastric mucosa in the GI tract. The ‘congenital theory’ proposes that GH results from an inborn error in the descent of the stomach during embryogenesis . While this might explain the genesis of GH in the cervical oesophagus (the ‘inlet patch’), it fails to account for the presence of GH elsewhere in the GI tract.…”

“…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 …”

“…Clinically, GH of the distal GI tract may present with (i) specific distal bowel/rectal symptoms, (ii) non‐specific abdominal symptoms or (iii) as an incidental finding . Haematochezia has been the most frequently reported specific distal bowel‐related symptom, followed by anal pain, tenesmus, burning or anal pruritus . There are rare instances of life‐threatening haemorrhage .…”