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Gastroenterology (Expert Forum)
exocrine pancreatic metaplasia seen in esophagus
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
exocrine pancreatic metaplasia seen in esophagus
by michellert, Aug 22, 2006 12:00AM
37 female, x-ray tech, H/O endometriosis, adenomyosis, transitional cell bladder low grade CA at age 30, no re-occurrence. Been having epigastric, chest, and RUQ pain.
pain used to only occur during menses...now worsens when I receive depo-provera shot, and really worsened after a 2 week course of premarin and I got a mini-period.
Hida scan showed a 24% effraction rate,(their normal rate 30%) RUQ Ultrasound that included GB normal, all blood work normal, except elevated LDL chol, and phosphates were low July, and dropped lower in Aug. No weight loss, or vomiting. They are now sending me to surgeon re: GB.
Upper endoscopy in Apr. this yr. stomach biopsy showed reflux disease, but my main concern: the esophagus biopsy showed “zygomen granules in submucosal glands consistent with exocrine pancreatic metaplasia“. From what I understand, this is congenital or metaplastic process. Rare, if found in Upper GI Tract, found in stomach, have not seen anything about it in the esophagus, also can be found in other organs. My GI Dr. never told me I had this, he said my results showed reflux disease. When I got a copy of the report, I called back to question it and the nurse spoke to dr. and told me that this is sometimes seen, doesn't need a follow up, not cancer or pre-cancerous, and it seems it was an area he seen vs. a random sample biopsy, so he removed it, he got it out, no need to be concerned.
I am concerned because I still have pain, and I don’t understand it. Was mine congenital? or metaplastic process, and if so why? Why would pancreatic cells grow in the esophagus? Can it cause problems even if it‘s removed? Can it Re-occur? Could it be mimicking something else? Can it be lurking in another organ undetected? Or related to any other medical problem I need to address?
Why do I have these conditions where tissue is growing where it shouldn’t be?
Actual Report:
operative findings: mucosal surface at gastroesophageal junction inflamed, no ulcers, strictures, or lesions,...gastric mucosa appears normal, no hiatal hernia, 1st & 2nd portions of duodenem normal
Stomach, Antrum Gastroscopy with biopsy: -gastric antral mucosa fragment -minimal chronic inflammation of lamina propria -no active inflammation observed -no specific inflammatory features observed -no helicobacter pylori type organisms observed.... -the positive and negative control slides for the helicobacter stain react appropriately -no epithelial dysplasia or malignancy
Esophagus, gastroscopy with biopsies -squamous & gastric cardia type glandular mucosa fragments -moderate chronic inflammation with focal eosinophils in lamina propria, consistent with chronic reflux/peptic esophagitis -zygomen granules in submucosal glands consistent with exocrine pancreatic metaplasia -no diagnostic goblet cell intestinal metaplasia or other histological features specific for ...Barrett’s metaplasia observed -no epithelial dysplasia or malignancy observed
pain used to only occur during menses...now worsens when I receive depo-provera shot, and really worsened after a 2 week course of premarin and I got a mini-period.
Hida scan showed a 24% effraction rate,(their normal rate 30%) RUQ Ultrasound that included GB normal, all blood work normal, except elevated LDL chol, and phosphates were low July, and dropped lower in Aug. No weight loss, or vomiting. They are now sending me to surgeon re: GB.
Upper endoscopy in Apr. this yr. stomach biopsy showed reflux disease, but my main concern: the esophagus biopsy showed “zygomen granules in submucosal glands consistent with exocrine pancreatic metaplasia“. From what I understand, this is congenital or metaplastic process. Rare, if found in Upper GI Tract, found in stomach, have not seen anything about it in the esophagus, also can be found in other organs. My GI Dr. never told me I had this, he said my results showed reflux disease. When I got a copy of the report, I called back to question it and the nurse spoke to dr. and told me that this is sometimes seen, doesn't need a follow up, not cancer or pre-cancerous, and it seems it was an area he seen vs. a random sample biopsy, so he removed it, he got it out, no need to be concerned.
I am concerned because I still have pain, and I don’t understand it. Was mine congenital? or metaplastic process, and if so why? Why would pancreatic cells grow in the esophagus? Can it cause problems even if it‘s removed? Can it Re-occur? Could it be mimicking something else? Can it be lurking in another organ undetected? Or related to any other medical problem I need to address?
Why do I have these conditions where tissue is growing where it shouldn’t be?
Actual Report:
operative findings: mucosal surface at gastroesophageal junction inflamed, no ulcers, strictures, or lesions,...gastric mucosa appears normal, no hiatal hernia, 1st & 2nd portions of duodenem normal
Stomach, Antrum Gastroscopy with biopsy: -gastric antral mucosa fragment -minimal chronic inflammation of lamina propria -no active inflammation observed -no specific inflammatory features observed -no helicobacter pylori type organisms observed.... -the positive and negative control slides for the helicobacter stain react appropriately -no epithelial dysplasia or malignancy
Esophagus, gastroscopy with biopsies -squamous & gastric cardia type glandular mucosa fragments -moderate chronic inflammation with focal eosinophils in lamina propria, consistent with chronic reflux/peptic esophagitis -zygomen granules in submucosal glands consistent with exocrine pancreatic metaplasia -no diagnostic goblet cell intestinal metaplasia or other histological features specific for ...Barrett’s metaplasia observed -no epithelial dysplasia or malignancy observed
Doctor's Answer
by Kevin Pho, MD, Aug 23, 2006 12:00AM
, Aug 23, 2006 12:00AM
I agree with the assessment that this is a rare process that can be congenital in nature. To my knowledge, there does not seem to be an increased risk of complications from this - removal via endoscopy was appropriate.
If the pain continues, it can be from the lowered gallbladder ejection fraction. Other upper GI disorders can be tested for, using a gastric emptying scan or 24-hr pH study.
Regarding the pancreatic metaplasia, there is a possibility that it can return. Periodic endoscopies can be considered to monitor this. If there continues to be questions, you can obtain a second GI opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
If the pain continues, it can be from the lowered gallbladder ejection fraction. Other upper GI disorders can be tested for, using a gastric emptying scan or 24-hr pH study.
Regarding the pancreatic metaplasia, there is a possibility that it can return. Periodic endoscopies can be considered to monitor this. If there continues to be questions, you can obtain a second GI opinion.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Member Comments (1)
by michellert, Aug 23, 2006 12:00AM
To: Dr. Kevin /Everyone
Is this a process as in a lesion, you remove it, and it's gone, unless it comes back, or can it be something that is just always present in my esophagus? My report said no lesions were found, I think they found this pancreatic metaplasia process through the random biopsy, I don't think there was a specific area of suspicion and removal.
