Yang Qun-Ying, Xu Jing, Hu Jian-Wen, Huang Xiao-Dong
Department of Gastroenterology, Dongyang People's Hospital, Dongyang 322100, Zhejiang Province, China.
Department of Pathology, Affiliated Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China.
World J Gastrointest Surg. 2025 Apr 27;17(4):102730. doi: 10.4240/wjgs.v17.i4.102730.
Heterotopic gastric mucosa (HGM) is the most common type of epithelial heterotopia, which can occur in any part of the gastrointestinal tract. The duodenum is one of the common sites of HGM. HGM is usually considered benign, and malignant transformation of HGM in the duodenum is extremely rare.
We reported a middle-aged man admitted to the hospital due to abdominal pain, whose gastroduodenoscopy revealed a polypoid uplift in the duodenum. The attending physician directly removed the lesion using a snare, histopathological analysis demonstrated multidirectional cellular differentiation on the basis of duodenal HGM. The hematoxylin and eosin stains of the duodenal lesion demonstrated HGM, the superficial mucosa exhibited gastric foveolar-type epithelium, numerous mucous glands were identified beneath the foveolar region. Additionally, focal areas displayed several signet-ring cell changes. Gastric foveolar-type epithelium was diffusely positivity for MUC5AC and Ki67. Numerous mucous gland was positivity for MUC6, partially positive for MUC2, pepsinogen I and H/K ATPase. It was eventually diagnosed gastric adenocarcinoma of fundic gland mucosa on the basis of duodenal HGM.
We reported the first case of gastric adenocarcinoma of fundic gland mucosa arising in the duodenum on the basis of HGM. Although HGM is mostly benign, there is also a risk of carcinogenesis.
异位胃黏膜（HGM）是最常见的上皮异位类型，可发生于胃肠道的任何部位。十二指肠是HGM的常见部位之一。HGM通常被认为是良性的，十二指肠HGM发生恶性转化极为罕见。
我们报告了一名因腹痛入院的中年男性，其胃镜及十二指肠镜检查显示十二指肠有息肉样隆起。主治医师直接用圈套器切除了病变，组织病理学分析显示在十二指肠HGM的基础上存在多向细胞分化。十二指肠病变的苏木精-伊红染色显示为HGM，表层黏膜呈现胃小凹型上皮，在小凹区域下方可见大量黏液腺。此外，局部区域出现了一些印戒细胞改变。胃小凹型上皮对MUC5AC和Ki67呈弥漫性阳性。大量黏液腺对MUC6呈阳性，对MUC2、胃蛋白酶原I和H/K ATP酶呈部分阳性。最终根据十二指肠HGM诊断为胃底腺黏膜腺癌。
我们报告了首例基于HGM发生于十二指肠的胃底腺黏膜腺癌病例。虽然HGM大多为良性，但也存在癌变风险。
