十二指肠幽门腺腺瘤的内窥镜特征：14 例患者的病例系列

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY DEN open Pub Date : 2024-11-19 DOI:10.1002/deo2.70038

Takeshi Uozumi, Satoru Nonaka, Yasuhiko Mizuguchi, Haruhisa Suzuki, Seiichiro Abe, Shigetaka Yoshinaga, Shigeki Sekine, Yutaka Saito

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摘要

背景幽门腺腺瘤（PGA）是十二指肠腺瘤的一个独特亚型。越来越多的人认为幽门腺腺瘤在组织学和分子学上是一个独特的实体；然而，其内窥镜特征尚未得到精确描述。本研究旨在探讨十二指肠 PGA 的内镜特征，包括其假定前体布鲁纳腺增生（BGH）与胃上皮异位/增生（GEM/H）之间的关联。方法本研究是一项单中心、回顾性病例系列研究。从病理数据库中检索了 14 例十二指肠 PGA 患者。PGA根据世界卫生组织的分类进行诊断。结果肿瘤中位大小为 22.5 毫米（范围：12-40 毫米），79% 的病例位于十二指肠的前段。6 例 PGA 表现为高级别发育不良。根据外观，PGA可分为两种亚型：绒毛状分叶型和光滑突出型。分别有28%和7%的病例在背景粘膜中发现了BGH和GEM/H。与对照组相比，BGH在PGA组的背景粘膜中含量更高（p <0.05）。6 例 PGA（43%）表现出高级别发育不良，低级别和高级别发育不良的内镜检查结果无明显差异。结论 14 名 PGA 患者的内镜检查结果具有特征性。BGH和GEM/H可能是PGA的前兆。

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Endoscopic features of the duodenal pyloric gland adenoma: A case series of 14 patients

Background

Pyloric gland adenoma (PGA) is a distinct subtype of duodenal adenoma. PGA has been increasingly recognized as a histologically and molecularly distinct entity; however, its endoscopic features have not been precisely described. This study aims to investigate the endoscopic characteristics of duodenal PGA, including the association of their putative precursors, Brunner's gland hyperplasia (BGH), and gastric epithelial heterotopia/metaplasia (GEM/H).

Methods

This study was a single-center, retrospective case series. Fourteen consecutive patients with duodenal PGA were retrieved from the pathological database. PGA was diagnosed according to the World Health Organization classification.

Results

The median tumor size was 22.5 mm (range: 12–40 mm), and 79% of cases were located in the first part of the duodenum. Six PGAs demonstrated high-grade dysplasia. PGA could be classified into two subtypes based on their appearance: villous lobulated type and smoothly protruding type. BGH and GEM/H were identified in the background mucosa in 28% and 7% of the cases, respectively. BGH was more abundant in the background mucosa of the PGA group than in the control group (p < 0.05). Six PGAs (43%) exhibited high-grade dysplasia, and no significant difference was observed in the endoscopic findings between low- and high-grade dysplasia.