Discussion
Ectopic duodenal mucosa with adenomatous hyperplasia in the stomach is extremely rare in clinical practice. In this paper, we describe a protuberant lesion in the gastric antrum, finally was pathologically diagnosed as ectopic duodenal mucosa. We hold the opinion that this disease is an adenomatoid hyperplasia of the duodenal gland on the basis of duodenal mucosa ectopia in stomach. Pathological examination showed that the tissues were well differentiated, with no obvious atypia and a benign development process.
Clinical analogues of this disease are gastric adenomas, pyloric adenomas, and gastric polyps. Duodenal Brunner adenoma is similar with this disease.
Gastric adenomas are benign polypoid lesions composed of neoplastic gastric epithelium, accounting for about 10% of gastric benign polypoid lesions, also known as adenomatous polyps or gastric polypoid dysplasia. Its nature belongs to gastric mucosal dysplasia/intraepithelial neoplasia, which is the precursor lesion of gastric cancer. They were divided into intestinal adenoma, pyloric adenoma, foveolar adenoma and acid-secreting adenoma.[2]
Pyloric gland adenoma (Pyloric gland adenoma) is a rare gastrointestinal tumor. Gastric pyloric adenomas arise in chronically damaged mucosa. The neoplastic glands had the differentiation of gastric pyloric glands and were tightly organized with occasional cystic dilatation. Individual cells were cuboidal to columnar, with eosinophilic to amphoteric cytoplasm, and imucosal or mucinous tectum poorly formed. The nuclei were round to ovoid with occasional prominent nucleoli. By immunohistochemistry, tumor cells marked gastric pyloric gland differentiation markers, including MUC6 and MUC5AC.[3] Although its pyloric adenoma can be treated conservatively, it should be completely removed if possible, especially for large adenomas or pyloric adenomas showing high-grade features.[4]
Gastric polyps are sessile or pedunculated lesions that originate from the gastric epithelium or submucosa and protrude into the gastric cavity. Malignant potential: According to the histological type, some gastric polyps (adenomas and hyperplastic polyps) have malignant potential and are a precursor to early gastric cancer. They may also indicate an increased risk of intestinal or extraintestinal malignancies.[5]
Duodenal Brunner adenoma refers to the presence of fundic gland tissue in the lamina propria mucosa of the duodenal bulb, that is, well differentiated gastric glands containing complete chief cells and parietal cells can be seen in the lamina propria mucosa of the duodenal bulb. They were usually polypoid nodules, granular or flat uplift, part of the gastric mucosa wrinkle-like uplift, cobblestone-like uplift, cauliflower-like uplift, etc., with different sizes and numbers, often multiple. Duodenal Brunner adenoma should be removed early and examined pathologically to prevent serious complications.[6]
In summary, ectopic duodenal mucosa with adenomatous hyperplasia in the stomach is generally benign. In order to confirm the diagnosis and avoid canceration, ulcer, bleeding and other complications, complete endoscopic resection of the goitre with pathological examination is appropriate.