Universidad Centrooccidental Lisandro Alvarado Pembroke Pines, FL
Nathaly Cortez, MD1, Yohelys B. Lobaton, MD2, Anna C. Willet, MD1, Manuel Berzosa, MD1, Ruben G. Delgado, MD1, Robert I. Goldberg, MD1; 1Mount Sinai Medical Center, Miami Beach, FL; 2Universidad Centrooccidental Lisandro Alvarado, Miami, FL
Introduction: Gastric heterotopia (GH) is a histopathological diagnosis, defined as the presence of gastric tissue away from its normal location. The most common locations within the gastrointestinal tract include the esophagus and duodenum. Rarely, GH localizes in the rectum. Presentation is very diverse and includes hematochezia, abdominal pain, rectovesical fistula, or even asymptomatic. Endoscopically, it can present as a small sessile polyp, diverticulum, or ulcer. Treatment options include endoscopic mucosal resection (EMR), surgical excision, and H2 receptor blockers.
Methods: A 50-year-old male presented to the gastroenterology office for colon cancer screening. He has no significant past medical history or family history of colon cancer. He denied constipation, diarrhea, rectal pain, hematochezia, abdominal pain, or weight loss. Perianal fistula or anal ulceration was not present. Colonoscopy revealed four sessile polyps. Three of them had a typical endoscopic appearance of adenomatous polyps; one in the ileocecal valve and two in the ascending colon. Of these, two were removed with EMR and one with a hot snare. Histopathology revealed sessile serrated adenomas in all polyps. The fourth polyp was located in the mid-rectum, measured 20-25 mm, and was classified as a 0-IIa lesion on Paris classification. However, it had an atypical appearance for a laterally spreading tumor, as it looked more like a “patch” of irregular congested mucosa (Fig. 1) without the typical pit-pattern of an adenoma. The decision was made not to completely remove the lesion and four biopsies were taken from the edges for histological evaluation. Histopathology from all the biopsies revealed normal gastric mucosa. Due to its size and location, we plan to repeat colonoscopy in 3 months to assess for dysplasia, and to remove the polyp by EMR. Discussion: GH in the rectum is rare and it can present as an asymptomatic sessile polypoid lesion.However, due to the reported malignant transformation of GH in the rectum, lesions are usually removed. We need more awareness since GH can be erroneously diagnosed as a contamination of the specimen with tissue from other biopsy sites. In our institution, biopsies are done with a non-reusable biopsy forceps and different forceps are used for foregut and colonic biopsies, even if both procedures are performed on the same day. All the specimens submitted from this patient were reviewed carefully with pathology to exclude the possibility of any tissue misplacement.
Figure 1. A sessile polyp in mid-rectum is shown with an atypical flattened appearance
Disclosures: Nathaly Cortez indicated no relevant financial relationships. Yohelys Lobaton indicated no relevant financial relationships. Anna Willet indicated no relevant financial relationships. Manuel Berzosa indicated no relevant financial relationships. Ruben Delgado indicated no relevant financial relationships. Robert Goldberg indicated no relevant financial relationships.