Difference between revisions of "Gastric heterotopia of the duodenum"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      =  
| Image      = Gastric heterotopia in the duodenum -- high mag.jpg
| Width      =
| Width      =
| Caption    =  
| Caption    = Gastric heterotopia in the duodenum. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| Micro      = foveolar epithelium, gastric glands (body-type or antral-type), small bowel mucosa +/-Brunner's glands
| Subtypes  =
| Subtypes  =
| LMDDx      =
| LMDDx      = foveolar metaplasia (isolated) - see [[chronic duodenitis]], foveolar gastric-type dysplasia, [[intestinal metaplasia of the stomach]]
| Stains    =
| Stains    =
| IHC        =
| IHC        =
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| Molecular  =
| Molecular  =
| IF        =
| IF        =
| Gross      =
| Gross      = nodules/polyps
| Grossing  =
| Grossing  =
| Staging    =
| Staging    =
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#Foveolar epithelium.
#Foveolar epithelium.
#Gastric glands - body-type or antral-type.
#Gastric glands - body-type or antral-type.
*Small bowel mucosa +/- Brunner's glands.


DDx:
DDx:
*Foveolar metaplasia (isolated) - see [[chronic duodenitis]].
*Foveolar metaplasia (isolated) - see [[chronic duodenitis]].
*Foveolar gastric-type dysplasia.<ref>{{Cite journal  | last1 = Park | first1 = do Y. | last2 = Srivastava | first2 = A. | last3 = Kim | first3 = GH. | last4 = Mino-Kenudson | first4 = M. | last5 = Deshpande | first5 = V. | last6 = Zukerberg | first6 = LR. | last7 = Song | first7 = GA. | last8 = Lauwers | first8 = GY. | title = Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia. | journal = Am J Surg Pathol | volume = 32 | issue = 4 | pages = 524-33 | month = Apr | year = 2008 | doi = 10.1097/PAS.0b013e31815b890e | PMID = 18300795 }}</ref>
*Foveolar gastric-type dysplasia.<ref>{{Cite journal  | last1 = Park | first1 = do Y. | last2 = Srivastava | first2 = A. | last3 = Kim | first3 = GH. | last4 = Mino-Kenudson | first4 = M. | last5 = Deshpande | first5 = V. | last6 = Zukerberg | first6 = LR. | last7 = Song | first7 = GA. | last8 = Lauwers | first8 = GY. | title = Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia. | journal = Am J Surg Pathol | volume = 32 | issue = 4 | pages = 524-33 | month = Apr | year = 2008 | doi = 10.1097/PAS.0b013e31815b890e | PMID = 18300795 }}</ref>
*[[Stomach with intestinal metaplasia]].


===Images===
===Images===

Revision as of 12:43, 3 May 2016

Gastric heterotopia of the duodenum
Diagnosis in short

Gastric heterotopia in the duodenum. H&E stain.

LM foveolar epithelium, gastric glands (body-type or antral-type), small bowel mucosa +/-Brunner's glands
LM DDx foveolar metaplasia (isolated) - see chronic duodenitis, foveolar gastric-type dysplasia, intestinal metaplasia of the stomach
Gross nodules/polyps
Site duodenum

Prevalence relatively common ~15%
Prognosis benign
Clin. DDx duodenal polyp, duodenal ulcer, tumour/submucosal tumour, duodenal carcinoma, duodenitis

Gastric heterotopia of the duodenum is a relatively common finding of the duodenum.

General

Clinical DDx:[3]

Classification

According to Terada it can be subdivided into:[3]

  1. Foveolar epithelium with gastric pits
  2. Foveolar epithelium only.

Note:

  • This article considers the former (foveolar epithelium with gastric pits) as gastric heterotopia. The later (foveolar epithelium only) is dealt with in the context of peptic duodenitis.

Gross

  • Typically nodules/polyps.[4]

Microscopic

Features:

  1. Foveolar epithelium.
  2. Gastric glands - body-type or antral-type.
  • Small bowel mucosa +/- Brunner's glands.

DDx:

Images

www:

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 DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA WITH GASTRIC (BODY-TYPE) HETEROTOPIA.
- NEGATIVE FOR SIGNIFICANT PATHOLOGY.

Alternate

DUODENUM, BIOPSY:
- SMALL BOWEL MUCOSA AND BRUNNER'S GLANDS WITHIN NORMAL LIMITS.
- GASTRIC HETEROTOPIA, BODY-TYPE MUCOSA.

See also

References

  1. 1.0 1.1 Terada, T. (2012). "Pathologic observations of the duodenum in 615 consecutive duodenal specimens: I. benign lesions.". Int J Clin Exp Pathol 5 (1): 46-51. PMID 22295146.
  2. Genta, RM.; Kinsey, RS.; Singhal, A.; Suterwala, S. (Nov 2010). "Gastric foveolar metaplasia and gastric heterotopia in the duodenum: no evidence of an etiologic role for Helicobacter pylori.". Hum Pathol 41 (11): 1593-600. doi:10.1016/j.humpath.2010.04.010. PMID 20656325.
  3. 3.0 3.1 Terada, T. (Mar 2011). "Heterotopic gastric mucosa of the gastrointestinal tract: a histopathologic study of 158 cases.". Pathol Res Pract 207 (3): 148-50. doi:10.1016/j.prp.2010.12.004. PMID 21242038.
  4. Shousha, S.; Spiller, RC.; Parkins, RA. (Jan 1983). "The endoscopically abnormal duodenum in patients with dyspepsia: biopsy findings in 60 cases.". Histopathology 7 (1): 23-34. PMID 6840712.
  5. Park, do Y.; Srivastava, A.; Kim, GH.; Mino-Kenudson, M.; Deshpande, V.; Zukerberg, LR.; Song, GA.; Lauwers, GY. (Apr 2008). "Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia.". Am J Surg Pathol 32 (4): 524-33. doi:10.1097/PAS.0b013e31815b890e. PMID 18300795.