Gastric heterotopia of the duodenum

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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 of the duodenum, 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.
  3. Small bowel mucosa +/- Brunner's glands.

DDx:

Images

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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.