Toussaint C, Libbrecht L, Dano H, Piessevaux H
Cliniques Universitaires St Luc, Department of Internal Medicine, Gastroenterology, Brussels, Belgium.
Cliniques Universitaires St Luc, Departement of Pathology, Brussels, Belgium.
Acta Gastroenterol Belg. 2019 Apr-Jun;82(2):257-260.
It has recently been shown that duodenal foveolar gastric metaplasia (FGM) sometimes presents as a polyp. The mechanism by which FGM develops into a polypoid lesion is unknown and it is unclear whether this form of FGM is indistinguishable from other polypoid lesions or whether endoscopists do not recognize it because they are unfamiliar with it. We identified and retrieved archival cases of FGM endoscopically suspicious for adenomatous polyp and examined their pathological, clinical and endoscopic features. Endoscopic features of the 13 identified FGMs presenting as polyps were heterogeneous and overlapping with those of adenomatous polyps. FGM was frequently associated with mucosal and submucosal Brunner's glands, but defining and recognizing hyperplasia of these glands remains difficult. Other pathological features could not explain the development of a polypoid lesion. The endoscopic features of FGM polyps are non-specific, overlapping with those of adenomatous polyps. FGM polyps probably acquire their polypoid aspect due to association with Brunner's gland hyperplasia (BGH), which also arises due to chronic inflammation and damage. Because BGH is ill-defined and difficult to recognize, while FGM is diagnosed easily, this type of polypoid lesions has until now only been recognized based on the presence of FGM, although FGM is most likely a secondary phenomenon and not the primary cause of the polyp.
最近研究表明，十二指肠小凹型胃化生（FGM）有时表现为息肉。FGM发展为息肉样病变的机制尚不清楚，这种形式的FGM是否与其他息肉样病变难以区分，或者内镜医师是否因不熟悉而无法识别，目前也尚不清楚。我们识别并检索了内镜检查怀疑为腺瘤性息肉的FGM存档病例，并检查了它们的病理、临床和内镜特征。13例表现为息肉的FGM的内镜特征具有异质性，且与腺瘤性息肉的特征重叠。FGM常与黏膜及黏膜下的Brunner腺有关，但对这些腺体增生的定义和识别仍然困难。其他病理特征无法解释息肉样病变的发生。FGM息肉的内镜特征不具有特异性，与腺瘤性息肉的特征重叠。FGM息肉可能因其与Brunner腺增生（BGH）相关而呈现息肉样外观，而BGH也是由慢性炎症和损伤引起的。由于BGH定义不明确且难以识别，而FGM易于诊断，所以到目前为止，这类息肉样病变仅基于FGM的存在而被识别，尽管FGM很可能是一种继发现象，而非息肉的主要病因。
