Spotted a small nodule (0.4 cm) in the upper esophagus with pinpoint central erosion...
Below the strip of squamous epithelium, which is focally ulcerated with patchy inflammation, is a circumscribed collection of cardiac-fundic-type glands comprised by parietal (plump pink) and chief cells along with scattered foveolar-type epithelium (not shown here).
Turned out to be ectopic gastric mucosa (stomach tissue) or ...
Gastric heterotopia of the upper esophagus!
Also called "inlet patch", this lesion is thought to be congenital and is usually located near the upper esophageal sphincter. The majority are asymptomatic and incidentally found; however, gastric acid secretion (those darn parietal cells!) is possible and dysphagia reported by some. Rare complications can include stricture, perforation, and, rarer still, adenocarcinoma.
The decedent died of hypertensive and atherosclerotic cardiovascular disease with evidence of remote infarct with potential acute component (histology pending). Cardiac work-up a few months prior to death was inconclusive and the patient continued to complain of and self-treat "heartburn" symptoms. Possible that heart was entirely the source of the symptoms misinterpreted as heartburn. Also possible that, although quite small, the lesion could have contributed to the symptoms the decedent experienced in months prior to his death.
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