The outlet patch: Gastric heterotopia of the colorectum and anus

Abul A.S.R. Mannan, Michael Vieth, Armen Khararjian, Binny Khandakar, Dora Lam-Himlin, David Heydt, Feriyl Bhaijee, Henry J. Venbrux, Kathleen Byrnes, Lysandra Voltaggio, Norman Barker, Songyang Yuan, Elizabeth A. Montgomery

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalHistopathology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Anal Canal
Stomach
Gastric Mucosa
Adenocarcinoma
Rectum
Adenoma
Descending Colon
Ascending Colon
Hemorrhoids
Gastrointestinal Hemorrhage
Diverticulum
Colonoscopy
Polyps
Helicobacter pylori
Ulcer
Habits
Gastrointestinal Tract
Colon
Mucous Membrane
Morbidity

Keywords

  • Gastric heterotopia
  • Heterotopia
  • Heterotopic gastric mucosa
  • Pyloric gland adenoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

Mannan, A. A. S. R., Vieth, M., Khararjian, A., Khandakar, B., Lam-Himlin, D., Heydt, D., ... Montgomery, E. A. (Accepted/In press). The outlet patch: Gastric heterotopia of the colorectum and anus. Histopathology. https://doi.org/10.1111/his.13632

The outlet patch : Gastric heterotopia of the colorectum and anus. / Mannan, Abul A.S.R.; Vieth, Michael; Khararjian, Armen; Khandakar, Binny; Lam-Himlin, Dora; Heydt, David; Bhaijee, Feriyl; Venbrux, Henry J.; Byrnes, Kathleen; Voltaggio, Lysandra; Barker, Norman; Yuan, Songyang; Montgomery, Elizabeth A.

In: Histopathology, 01.01.2018.

Research output: Contribution to journalArticle

Mannan, AASR, Vieth, M, Khararjian, A, Khandakar, B, Lam-Himlin, D, Heydt, D, Bhaijee, F, Venbrux, HJ, Byrnes, K, Voltaggio, L, Barker, N, Yuan, S & Montgomery, EA 2018, 'The outlet patch: Gastric heterotopia of the colorectum and anus', Histopathology. https://doi.org/10.1111/his.13632
Mannan AASR, Vieth M, Khararjian A, Khandakar B, Lam-Himlin D, Heydt D et al. The outlet patch: Gastric heterotopia of the colorectum and anus. Histopathology. 2018 Jan 1. https://doi.org/10.1111/his.13632
Mannan, Abul A.S.R. ; Vieth, Michael ; Khararjian, Armen ; Khandakar, Binny ; Lam-Himlin, Dora ; Heydt, David ; Bhaijee, Feriyl ; Venbrux, Henry J. ; Byrnes, Kathleen ; Voltaggio, Lysandra ; Barker, Norman ; Yuan, Songyang ; Montgomery, Elizabeth A. / The outlet patch : Gastric heterotopia of the colorectum and anus. In: Histopathology. 2018.
@article{e68112d508954d339b98b13e7d74fb71,
title = "The outlet patch: Gastric heterotopia of the colorectum and anus",
abstract = "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.",
keywords = "Gastric heterotopia, Heterotopia, Heterotopic gastric mucosa, Pyloric gland adenoma",
author = "Mannan, {Abul A.S.R.} and Michael Vieth and Armen Khararjian and Binny Khandakar and Dora Lam-Himlin and David Heydt and Feriyl Bhaijee and Venbrux, {Henry J.} and Kathleen Byrnes and Lysandra Voltaggio and Norman Barker and Songyang Yuan and Montgomery, {Elizabeth A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1111/his.13632",
language = "English (US)",
journal = "Histopathology",
issn = "0309-0167",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - The outlet patch

T2 - Gastric heterotopia of the colorectum and anus

AU - Mannan, Abul A.S.R.

AU - Vieth, Michael

AU - Khararjian, Armen

AU - Khandakar, Binny

AU - Lam-Himlin, Dora

AU - Heydt, David

AU - Bhaijee, Feriyl

AU - Venbrux, Henry J.

AU - Byrnes, Kathleen

AU - Voltaggio, Lysandra

AU - Barker, Norman

AU - Yuan, Songyang

AU - Montgomery, Elizabeth A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Gastric heterotopia

KW - Heterotopia

KW - Heterotopic gastric mucosa

KW - Pyloric gland adenoma

UR - http://www.scopus.com/inward/record.url?scp=85047737217&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047737217&partnerID=8YFLogxK

U2 - 10.1111/his.13632

DO - 10.1111/his.13632

M3 - Article

AN - SCOPUS:85047737217

JO - Histopathology

JF - Histopathology

SN - 0309-0167

ER -