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LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 848-849
A rare case of a rectal polyp with gastric heterotopia


1 Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India

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Date of Web Publication6-Jan-2012
 

How to cite this article:
Kokil G, Pulimood A, Mathai J. A rare case of a rectal polyp with gastric heterotopia. Indian J Pathol Microbiol 2011;54:848-9

How to cite this URL:
Kokil G, Pulimood A, Mathai J. A rare case of a rectal polyp with gastric heterotopia. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Oct 14];54:848-9. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/848/91521


Sir,

Heterotopic gastric mucosa has been reported all along the alimentary tract, including the tongue, oesophagus, small intestine, biliary tract, gall bladder, colon, and rectum, the most common site being in Meckel's diverticulum. In addition, heterotopic gastric mucosa has been described in the mediastinum, face, spinal cord, and umbilicus. However, heterotopic gastric mucosa in the rectum is a rare disorder. [1]

A 12-year-old boy presented with a history of painless bleeding per rectum for 10 years with a mass descending per rectum for a few days. The rectal examination revealed a 1 × 1 cm sessile polyp, 3 cm from the anal verge. The polypectomy specimen measured 3.5 × 2 × 1 cm and had edematous mucosa and a light brown soft cut surface. The microscopic examination showed a polyp, composed of a central core of loose connective tissue and covered by gastric body and antral type mucosa [Figure 1]. The Alcian blue-Periodic acid Schiff stain confirmed the presence of neutral mucin in the gastric mucosa [Figure 2]. However, there were no Helicobacter pylori organisms seen. There was no evidence of any dysplasia or malignancy.
Figure 1: Rectal polyp lined by gatric body and antral type mucosa (hematoxylin and eosin, ×50)

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Figure 2: Alcian blue-periodic acid Schiff stain gastric and colonic mucosa (A PAS, ×10)

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Gastric heterotopia of the rectum is a rare entity with less than 50 cases reported in the literature. [1] This lesion is more common in males with an average age of presentation being 21 years. [2] Endoscopically, the gastric heterotopia is frequently seen as a polyp. [3] The most common presentation is rectal bleeding with a mass descending per rectum, as is in our case. [4] The diagnosis is based on microscopic examination. One can find gastric body, pyloric, antral, chief, and parietal cells in the lesion. Helicobacter pylori organisms can colonize this gastric mucosa and cause ulceration and bleeding. However, our case did not show any Helicobacter pylori organisms. The definite treatment is complete excision. [4] The fact that gastric heterotopia in the esophagus and jejunum is known to undergo malignant transformation emphasizes the importance of the diagnosis of heterotopic gastric mucosa in the rectum. [5] In cases of malignant transformation, fundic type of gastric mucosa is seen adjacent to the carcinoma with intervening mucosa showing areas of dysplasia. At the same time it is advisable to repeat a thorough gastrointestinal endoscopy to look for this lesion at other sites.

 
   References Top

1.Sauer CG, Bickston SJ, Borowitz SM. Gastric heterotopia of the rectum. J Pediatr Gastroenterol Nutr 2010;50:329-33.  Back to cited text no. 1
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2.Steele SR, Mullenix PS, Martin MJ, Ormseth E, Weppler E, Graham J, et al. Heterotopic gastric mucosa of the anus: A case report and review of literature. Am Surg 2004;70:715-9.  Back to cited text no. 2
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3.Prakash S, Veliath AJ, Chandrasekharan V. Ectopic gastric mucosa in duplication of the rectum presenting as a perianal fistula. Dis Colon Rectum 1982;25:225-6.  Back to cited text no. 3
    
4.Konrad AD, Miick R, Pineda JJ, Diaz-Arias AA. Gastric Heterotopia presenting as a rectal polyp. Internet J Gastroenterol 2007;6.  Back to cited text no. 4
    
5.Christensen WN, Sternberg SS. Adenocarcinoma of the upper esophagus arising in ectopic gastric mucosa, two case reports and review of literature. Am J Surg Pathol 1987;11:397-402.  Back to cited text no. 5
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Correspondence Address:
Gautami Kokil
Department of General Pahtology, Christian Medical College and Hospital, Vellore, Tamil Nadu - 632 004
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91521

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