Intragastric ectopic liver

Authors

• Jessy Fadel Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon
• Philippe Attieh Department of General surgery, University of Balamand, Beirut, Lebanon
• Karam Karam Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon
• Paul Rassam Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon
• Zarouhie Meguerian Department of Pathology, St George University of Beirut, Beirut, Lebanon
• Elias Fiani Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon; Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon
• Ihab I. El Hajj Department of Gastroenterology and Hepatology, St George University of Beirut, Beirut, Lebanon; Department of Gastroenterology and Hepatology, University of Balamand, Beirut, Lebanon

karamek7@gmail.com

Keywords

Abstract

Background: Ectopic liver (EL) is a rare developmental anomaly defined as hepatic tissue located outside the native liver without vascular or biliary continuity. It is most commonly reported in the gallbladder but has also been described in other intra-abdominal and extra-abdominal sites. The gastric location is exceptionally rare, with only a handful of cases reported in the literature.
Case presentation: We present the case of a 49-year-old previously healthy male with a 2-month history of dyspepsia and heartburn who underwent diagnostic gastroscopy. This latter showed a 15 mm antral submucosal lesion with central umbilication. Endoscopic ultrasound (EUS) of the lesion showed a well-defined, hypoechoic, heterogeneous 14.2 × 8 × 10.4 mm mass involving the mucosa, muscularis mucosa, and submucosa. EUS-guided fine needle biopsy using a 22 G needle yielded adequate tissue. Histopathological examination demonstrated normal hepatocyte plates with one-cell thickness, highlighted by reticulin staining. Special stains, including Perl’s iron, periodic acid Schiff (PAS), and PAS with diastase, showed no abnormal inclusions or hemosiderin deposits, and no pancreatic or ductal structures were identified. These findings were diagnostic of ectopic liver tissue. The lesion showed no evidence of malignancy.
Discussion: EL is usually detected incidentally during surgery or autopsy, and preoperative diagnosis is challenging due to its small size, asymptomatic course, and unfamiliarity among clinicians. Gastric EL is exceedingly rare, with only 3 cases previously described in the pylorus or fundus. Our case is unique as it represents the first reported antral location and was diagnosed preoperatively with EUS-guided biopsy.
Conclusion: Although rare, EL should be considered in the differential diagnosis of gastric submucosal lesions. Histological confirmation is essential to exclude malignant transformation.

References