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.