Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases

Abstract

Aim: The inlet patch, also called as the heterotopic gastric mucosa, is often located in proximal esophagus and is generally asymptomatic. These lesions are rarely polypoid and mostly have a patchy pattern. In the literature, there are only few cases of inlet patches that show a malignant progression following a metaplasia- dysplasia- adenocarcinoma sequence. In our study, we aimed to present the endoscopic and morphological features of our case series. Methods: The study, which was conducted in two clinics, included the inlet patch cases diagnosed in esophagus biopsy materials between 2016 and 2019. The slides and the demographic data of the cases were re-analyzed. Results: Among 4190 cases whose esophageal biopsies were examined, 63 inlet patches (1.5%) were diagnosed. Thirty four cases were male and 29 were female. Age range was 16-82 years. The cases were mostly located in proximal esophagus and the size of the lesions ranged between 0.2-3.5 cm. One of the four cases with polypoid appearance was microscopically diagnosed as a hyperplastic polyp. The most common gastric type epithelium was the oxyntic type. Helicobacter pylori was observed in four cases, and intestinal metaplasia and low-grade dysplasia were observed in one. No malignancy was diagnosed in our series. Conclusion: Although benign, the inlet patch is significant due to its risk of progression to malignancy. Thus, obtaining biopsies from each lesion endoscopically considered as inlet patch is recommended. This will help determine the precise incidence of the inlet patch and more importantly, identify neoplasia earlier.

Keywords

• ınlet patch
• esophagus
• polyp
• Dysplasia

Olgular eşliğinde özofagusta lokalize heterotopik gastrik mukozayı (inlet patch) tanıyalım

Öz

Amaç: Heterotopik gastrik mukoza olarak da adlandırılan inlet patch sıklıkla proksimal özofagusta lokalizedir. Genellikle asemptomatiktir. Polipoid yapıda seyrek saptanan bu lezyonlar, sıklıkla endoskopik olarak yamasal tarzda izlenir. Literatürde metaplazi-displaziadenokarsinom sekansını takiben malign progresyon gösterebilen az sayıda inlet patch olguları yer almaktadır. Çalışmamızda inlet patch tanılı olgu serimizi endoskopik ve morfolojik özellikleriyle sunmayı amaçladık. Yöntemler: Çalışma iki klinik üzerinden yürütüldü. Her iki klinikte 2016-2019 yılları arasında özofagusa ait biyopsi materyalleri içinde inlet patch tanısı alan olgular dahil edildi. Olgulara ait preparatlar ve demografik bilgiler tekrar gözden geçirildi. Bulgular: Özofagus biyopsisi incelenen 4190 olgu içinde 63 olgu (%1,5) inlet patch tanısı aldı. Olguların 34’ü erkek, 29’u kadındı. Olguların yaşları 16 ile 82 arasında değişmekteydi. En sık görüldüğü yaş aralığı 30-50 yaşdı. En sık proksimal özofagusta lokalizeydi (59 olgu). Lezyonların boyutları 0,2-3,5 cm arasında değişmekteydi. Polipoid görünümdeki dört olgudan biri histopatolojik olarak hiperplastik polip tanısı aldı. En sık gözlenen gastrik tip epitel oksintik tipti (29 olgu). Helikobakter pilori dört olguda izlendi. Olgulardan birinde intestinal metaplazi ve düşük dereceli displazi saptandı. Malignite tanısı olan olgumuz yoktu. Sonuç: Benign bir lezyon olmasına rağmen maligniteye dönüşüm riski nedeniyle inlet patch olgularının önemsenmesi gerekmektedir. Bu nedenle endoskopik incelemede inlet patch olarak saptanan her lezyondan biyopsi alınması, özellikle büyük boyut, ülser gibi farklı klinik tablo sergileyen olguların da yakın klinik takiplerinin yapılması bizlere inlet patchin gerçekte görülme sıklığının ne olduğunu ve en önemlisi gelişen neoplazilerin erken dönemde saptanmasına olanak sağlayacaktır.

Anahtar Kelimeler

• İnlet patch
• Özofagus
• Polip
• Displazi

Kaynakça

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