The authors present the case of a 23-year-old man with recurrent abdominal pain in the right hypochondrium. An abdominal ultrasound detected the presence in the gallbladder of an endoluminal cystic image near the infundibulum, immovable, of ring-like appearance, with a regular wall, measuring about 20 mm (Fig. 1).
An endoscopic ultrasound (EUS) was performed, confirming the presence of a homogeneously echogenic lesion with central low echogenicity, adherent to the gallbladder, measuring 18 mm (Fig. 2).
The patient was referred for cholecystectomy and a histopathological analysis was performed (Fig. 3).
Pathological analysis revealed a submucosal area of heterotopical gastric mucosa in the gallbladder, comprising mostly of gastric body mucosa and partly of pyloric mucosa. During follow-up for two years the patient was asymptomatic.
Heterotopic gastric mucosa (HGM) is most often localized in the upper intestine but it can be found in the whole gastrointestinal tract [1,2]. Rarely, it can also be localized in the gallbladder [1,2,3]. HGM in the gallbladder is frequently an incidental finding but it can also become symptomatic and can even present as an acute abdomen . Regarding diagnostic imaging, there are no characteristic findings to properly differentiate it from other usual polyps and adenocarcinoma . Although it had been previously considered to have potential for carcinogenesis, there have been no cases reported of malignant transformation .
Diogo Bernardo Moura, Nuno Nunes, Francisca Côrte-Real, Carolina Chálim Rebelo, Maria Antónia Duarte.
Gastroenterology Department, Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.