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The outlet patch: gastric heterotopia of the colorectum and anus
Author(s) -
Mannan Abul A S R,
Vieth Michael,
Khararjian Armen,
Khandakar Binny,
LamHimlin Dora,
Heydt David,
Bhaijee Feriyl,
Venbrux Henry J,
Byrnes Kathleen,
Voltaggio Lysandra,
Barker Norman,
Yuan Songyang,
Montgomery Elizabeth A
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13632
Subject(s) - medicine , rectum , gastroenterology , dysplasia , adenocarcinoma , ascending colon , anus , hyperplastic polyp , colonoscopy , pathology , colorectal cancer , surgery , cancer
Aims Gastric heterotopia ( GH ) has been described throughout the gastrointestinal tract. However, the colorectal region is an extremely rare location for it. We describe the clinicopathological features of GH of the colon, rectum and anus. Methods and results We identified 33 cases in 20 males and 13 females (median age = 54 years; range = 4 months–73 years). Sites included the rectum ( n = 26), anus ( n = 4), ileocaecal junction ( n = 1), ascending colon ( n = 1) and descending colon ( n = 1). Presenting symptoms ( n = 27) included haematochezia (41%) and altered bowel habits (4%); 15 patients (55%) were asymptomatic. On colonoscopy ( n = 31), all appeared as solitary lesions (median size = 6.5 mm, range = 2–55 mm), either as polyps (61%), raised erythematous patches (23%), an ulcer (10%), within a rectal diverticulum (3%) or a haemorrhoid (3%). Patients were managed by polypectomy. One with an associated carcinoma in the area of GH underwent resection. No morbidity related to GH itself was reported following excision. Histologically, heterotopic gastric mucosa was oxyntic (85%), mixed oxyntic and non‐oxyntic (12%) and not specified (3%) types. In five patients a pyloric gland adenoma ( PGA ) arose from heterotopic gastric mucosa, two of which contained a focus of invasive adenocarcinoma. One case had associated surface foveolar‐type low‐grade dysplasia. Another had associated adenocarcinoma arising from the heterotopic mucosa. One example harboured Helicobacter pylori organisms. Conclusions We highlight the features of GH in the distal GIT – the ‘outlet patch’. Association with PGA , surface dysplasia and adenocarcinoma suggests that lower tract GH can undergo neoplastic transformation.