De Vita O, Bondi A, Euse-Bi V, Bordi C
Am J Gastroenterol. 1984 Aug;79(8):606-10.
Seventeen years after a Billroth II gastric resection for duodenal ulcer had been performed, two large polypoid tumors were found in the gastric stump (outside the stomal area) and in the duodenal stump of a 69-year-old man. Histologically the neoplasms were tubular adenomas with small focal carcinomatous changes restricted to the gastric tumor. A distinctive feature of both tumors was the occurrence of three major cell populations segregated into two different types of neoplastic epithelium: one with columnar mucous cells containing gastric type mucins and mixed with a large number of argyrophil endocrine cells and the other with large, pleomorphic cells containing immunoreactive lysozyme and intestinal type mucins. In the absence of any evidence of generalized gastrointestinal polyposes, it is suggested that both tumors originated from the gastric mucosa (of heterotopic origin in the duodenum) and that the second type epithelium may represent a particular, and up to now unrecognized, type of intestinal metaplasia.
在一位69岁男性患者接受十二指肠溃疡毕罗Ⅱ式胃切除术后17年，在其胃残端（吻合口区外）和十二指肠残端发现了两个大的息肉样肿瘤。组织学检查显示，肿瘤为管状腺瘤，仅胃内肿瘤存在小灶性癌性改变。这两个肿瘤的一个显著特征是出现了三种主要细胞群，它们分隔在两种不同类型的肿瘤上皮中：一种是含有胃型黏液的柱状黏液细胞，并混有大量嗜银内分泌细胞；另一种是含有免疫反应性溶菌酶和肠型黏液的大的多形性细胞。由于没有任何全身性胃肠道息肉病的证据，提示这两个肿瘤均起源于胃黏膜（十二指肠内为异位起源），且第二种类型的上皮可能代表一种特殊的、迄今未被认识的肠化生类型。
