Pancreatic acinar metaplasia in an inlet patch
| Autor: | Patrick G. Brady, Martin E. Maldonado, M. Morgan |
|---|---|
| Rok vydání: | 1998 |
| Předmět: |
Male
Pancreatic acinar metaplasia medicine.medical_specialty Pathology Stomach Diseases H&E stain Choristoma Gastroscopy Eosinophilic Biopsy Gastric mucosa Humans Medicine Radiology Nuclear Medicine and imaging Reflux esophagitis Duodenoscopy Pancreas Submucosal glands Metaplasia medicine.diagnostic_test business.industry Gastroenterology Middle Aged medicine.disease Immunohistochemistry medicine.anatomical_structure Gastric Mucosa Esophageal Stenosis Histopathology Esophagogastric Junction Esophagoscopy business |
| Zdroj: | Gastrointestinal Endoscopy. 47:545-546 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/s0016-5107(98)70263-9 |
| Popis: | A 56-year-old man with a long-standing history of gastroesophageal reflux partially responsive to antacids and H2 blocker therapy was referred for further evaluation. He denied dysphagia. A barium swallow showed a proximal esophageal mucosal web associated with a defect interpreted as either a focal diverticulum or ulcer. An esophagogastroduodenoscopy was performed for further evaluation of these findings. One centimeter below the cricopharyngeus muscle there was a 2 cm localized area of heterotopic gastric mucosa juxtaposed to a short segment of asymmetric stenosis. The stenosis was mild and offered no resistance to the passage of the endoscope (Fig. 1). In the distal esophagus there were areas of linear erosions consistent with reflux esophagitis. A hiatal hernia was not identified. Biopsy specimens were taken from the inlet patch. Subsequently, the patient was treated with omeprazole 20 mg per day with a good response. This medication was continued long-term because the patient had responded well. He now has been followed for 1 year and remains asymptomatic. No further endoscopic procedures have been necessary. Formalin-fixed, paraffin-embedded tissues were cut in 4 mm thick sections and subjected to hematoxylin and eosin and immunohistochemical staining (IHC). IHC technique followed previously published work3 and used anti-lipase monoclonal antibody (Chemicon Inc., Temecula, Calif.) at a dilution of 1:6000. Hematoxylin and eosin microscopic sections showed a composite of mixed stratified squamous epithelial and gastric fundic type mucosa with a well-circumscribed collection of submucosal glands (Fig. 2). The glands form distinct tubular arrangements and consist of large, mononucleated roughly pyramidal cells containing monomorphic basally arrayed nuclei and ample amounts of intensely eosinophilic cytoplasm. Immunohistochemical staining of the submucosal glands with anti-lipase antibody showing intense granular cytoplasmic decoration, corresponding to zymogen-lipase enzymes located within the golgi apparatus (Fig. 3). These findings are consistent with pancreatic acinar metaplasia. |
| Databáze: | OpenAIRE |
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