Gastric Heterotopia
Epidemiology and Etiology:
- Incidental usually
- Association with concurrent fundic
gland polyps in the stomach (?PPI related)
Common sites:
- Bulb of duodenum
- Meckel diverticulum
Gross features:
- Small (< 1.0 cm) usually
- Multiple maybe
Histologic features:
- Well-organized oxyntic glands composed of chief
and parietal cells
- Overlying gastric foveolar-type mucinous
epithelium often
- H. pylori infection can occur here
- Secondary mucosal prolapse-type changes in large
heterotopias:
- Muscularis mucosae prominence
- Submucosal fibrosis
- Cystic dilation of oxyntic and mucinous glands
- Surface epithelial hyperplasia
- Distinction from gastric foveolar metaplasia:
- Active inflammation (maybe)
- Erosion or ulceration maybe
- Prominent Brunner glands
- No oxyntic glands (characteristic of gastric
heterotopia)
- Response to inflammation caused by peptic
injury associated with H. pylori
- Epigastric pain
- Duodenitis on scope
- Villous blunting
Immunophenotype:
Marker:
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Sensitivity:
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Specificity:
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Molecular features:
Other features:
- Asymptomatic usually (usually no clinical
implications)
- Larger polyps may manifest as masses causing
obstruction or intussusception
- Peptic ulceration is rare, but may occur with
massive GI bleeding with extensive heterotopias
References:
- Odze
& Goldblum (eds.) Surgical
Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas (3rd.
ed) (2015)