Case 1: Biopsy of a nodule at the duodenal bulb. Duodenal villi can be seen on the left side of image and a heterotopic rest of gastric glands can be seen on the right, underneath foveolar-type mucinous epithelium.
A closer look reveals the pink parietal cells and the more basophilic chief cells.
On the same biopsy, normal duodenum with Brunner glands can be appreciated.
Gastric heterotopia in the duodenal is most commonly identified in the bulb. Endoscopically, these heteropic rests are seen as small (<1.0cm) polypoid nodules. Microscopically, there are normal gastric glands composed of chief and parietal cells. The intestinal epithelium of the overlying surface are often replaced by gastric foveolar-type mucinous epithelium with adjacent normal duodenal mucosa.
Usually benign without clinical significance unless large enough to cause obstruction.
Contributed by Dr. Kate Sciandra, Dept of Pathology, VAMC Albuquerque New Mexico.