Heterotopic gastric mucosa in gallbladder—A rare differential diagnosis to gallbladder masses

Abstract

Background:Heterotopic gastric tissue can be found in the entire gastrointestinal tract. It is usually located in the upper intestine. Rarely, it can be found in the gallbladder. This study describes several clinically, imaging features as well as histopathology findings of heterotopic gastric tissue in gallbladder (HGM).Methods:The radiologic database of 1 tertiary university hospital was retrospectively screened for HGM. Additionally, a systemic review of the Medline database was conducted to identify previously published cases reports. In all cases clinical, imaging as well as histopathology features were retrieved from the papers.Results:In our databases, 1 patient with HGM was identified. Additionally, the systemic review yielded 32 suitable papers with 34 patients. Clinically, most of the patients suffered from abdominal discomfort. Most of the lesions were located in the lower gallbladder, especially (n = 14, 40%) in the gallbladder neck. On sonography, in 20.7% a broad-based mass was described. In 10.3% a sessile polyp was identified. In 5 cases, the mass was characterized as hyperechoic (55.5%), as isoechoic in 3 (33.3%) cases, and hypoechoic in 1 (11.1%). On computed tomography (CT), the lesions were most frequently hyperdense and all of them showed a slightly enhancement after application of contrast medium. On histopathology, most cases revealed heterotopic gastric mucosa of body-fundic type (60%) with chief and parietal cells, followed by pyloric type glands (20%). Every patient was treated with cholecystectomy and all had an uneventful recovery.Conclusion:HGM is a rare disorder with several differential diagnoses. Typically features were described to identify HGM in clinical routine and rule out malignant diseases like gallbladder carcinoma.

Imaging based flowchart for gallbladder polyp evaluation

“…[17][18][19]32,33 Our results indicate that these features may be missing from adenomyomatosis, and that microcysts may be detected in other types of nonneoplastic polyps. Gastric heterotopia, a rare type of polyp which has only been reported in 34 patients in literature, 34 mimicked cysts on both TAUS and MRI which were dilated glands on microscopy, and one cholesterol polyp demonstrated cysts on targeted TAUS.…”

Pretreatment with Lactobacillus fermentum XY18 Relieves Gastric Injury Induced by HCl/Ethanol in Mice via Antioxidant and Anti-Inflammatory Mechanisms

“…Unrestrained consumption of alcohol can activate the body’s immune system, causing great fluctuation in the serum levels of pro-inflammatory cytokines such as IL-6, interleukin-1β, and IFN-γ. 33 Gastric lesions continue to deteriorate in an inflammatory environment, which is closely related to the production of inflammatory mediators. 34 LAB can inhibit the rise of TNF-α and IFN-γ and increase the serum concentration of secretory immunoglobulin A, which is beneficial for alleviating gastric injury.…”

“… 52 Maintaining normal Cu/Zn-SOD and Mn-SOD levels in the body could efficaciously inhibit the spread of gastric lesions. 33 As an antioxidant enzyme, CAT has the function of removing hydrogen peroxide in the body and can play a role in resisting the gastric lesions caused by alcohol-induced oxidative stress. 53 The oxidative damage to gastric tissues caused by free radicals could be alleviated by maintaining the expression of active enzyme genes such as Cu/Zn-SOD, MN-SOD, and CAT in vivo.…”

Heterotopic Gastric Mucosa in the Gallbladder Simulating a Tumor: A Case Report

“…Regarding CT-findings, lesions were slightly hyperdens. There is paucity of MRI data regarding heterotopic gastric mucosa [14].…”