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Pancreatic heterotopia at the gastroesophageal junction
Digestive and Liver Disease 44 (2012) e16
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Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
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Pancreatic heterotopia at the gastroesophageal junction Ali Choukair, Lara Younan, Ala I. Sharara ∗ Division of Gastroenterology, Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
a r t i c l e
i n f o
Article history: Received 19 December 2011 Accepted 16 February 2012 Available online 22 March 2012
A 44 year old female presented with mild epigastric pain of few months duration. Esophagogastroduodenoscopy showed subtle flat polypoid tissue at the gastric cardia with a mosaic pattern on narrow band imaging (Fig. 1). Biopsies revealed pancreatic heterotopia with nests of acinar tissue located at the base of the mucosal glands with abundant eosinophilic and granular cytoplasm in the apical and middle portions and basophilic in the basal area (Fig. 2). Pancreatic heterotopias (PH), defined as pancreatic tissue lacking anatomical and vascular communication with the normal pancreas, can occur anywhere in the gastrointestinal tract (most commonly stomach followed by small bowel) but its biological significance remains uncertain. The prevalence of PH at the gastroesophageal junction (GEJ) ranges from 18 to 32%. These lesions are usually clinically silent. A malignant change is extremely rare. This entity has been commonly referred to as pancreatic acinar metaplasia since it was thought to be associated with chronic inflammation [1]. However, in a prospective study, no association with chronic gastritis was identified and patients with PH were significantly younger than those without PH raising the possibility of a congenital origin. PH found exclusively above the GEJ is associated with female gender, the presence of Helicobacter pylori while PH below the GEJ is inversely associated with female gender without association with H. pylori or reflux symptoms.
∗ Corresponding author at: American University of Beirut Medical Center, Beirut, Lebanon. E-mail address: [email protected] (A.I. Sharara).
Reference [1] Doglioni C, Laurino L, Dei Tos AP, et al. Pancreatic (acinar) metaplasia of the gastric mucosa. Histology, ultrastructure, immunocytochemistry, and clinicopathologic correlations of 101 cases. Am J Surg Pathol 1993;17:1134–43.
1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2012.02.008
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the month
Pancreatic heterotopia at the gastroesophageal junction Ali Choukair, Lara Younan, Ala I. Sharara ∗ Division of Gastroenterology, Department of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
a r t i c l e
i n f o
Article history: Received 19 December 2011 Accepted 16 February 2012 Available online 22 March 2012
A 44 year old female presented with mild epigastric pain of few months duration. Esophagogastroduodenoscopy showed subtle flat polypoid tissue at the gastric cardia with a mosaic pattern on narrow band imaging (Fig. 1). Biopsies revealed pancreatic heterotopia with nests of acinar tissue located at the base of the mucosal glands with abundant eosinophilic and granular cytoplasm in the apical and middle portions and basophilic in the basal area (Fig. 2). Pancreatic heterotopias (PH), defined as pancreatic tissue lacking anatomical and vascular communication with the normal pancreas, can occur anywhere in the gastrointestinal tract (most commonly stomach followed by small bowel) but its biological significance remains uncertain. The prevalence of PH at the gastroesophageal junction (GEJ) ranges from 18 to 32%. These lesions are usually clinically silent. A malignant change is extremely rare. This entity has been commonly referred to as pancreatic acinar metaplasia since it was thought to be associated with chronic inflammation [1]. However, in a prospective study, no association with chronic gastritis was identified and patients with PH were significantly younger than those without PH raising the possibility of a congenital origin. PH found exclusively above the GEJ is associated with female gender, the presence of Helicobacter pylori while PH below the GEJ is inversely associated with female gender without association with H. pylori or reflux symptoms.
∗ Corresponding author at: American University of Beirut Medical Center, Beirut, Lebanon. E-mail address: [email protected] (A.I. Sharara).
Reference [1] Doglioni C, Laurino L, Dei Tos AP, et al. Pancreatic (acinar) metaplasia of the gastric mucosa. Histology, ultrastructure, immunocytochemistry, and clinicopathologic correlations of 101 cases. Am J Surg Pathol 1993;17:1134–43.
1590-8658/$36.00 © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.dld.2012.02.008