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The Korean Journal of Pathology 1982;16(2): 187-198.
위점막하 조직에 출현하는 이소성 위점막성 상피소의 형태학적 특성과 의의에 관한 조직구축학적 연구
Histotopographic Study on Morphological Nature and Significance of Submucosal Epithelial Heterotopia in the Human Stomach
One thousand consecutive autopsy and gastrectomy stomachs were investigated by extended histotopographic method to identify the morphological nature and distribution of submucosal epithelial heterotopia of the stomach and to clarify its histogenesis in relation with the development of gastritis cystica profunda by determination of common denominators between two lesions. Submucosal epithelial heterotopia was found in 188 out of 1,000 Korean stomachs(18.8%), and the incidence increased with age up to 25.2% or more after the sixth decade. No single case of heterotopia was present in stomachs under the age of 20. Majority of heterotopic nests(87.2%) were composed of foveolar and/or mucous neck cells, being participated by loose supportive tissue corresponding to the lamina propria of the covering mucosa and in part by smooth muscle coat of muscularis mucosae origin. The antralized portion of stomach was the principal site of those heterotopia, but also both anterior and posterior walls of the fundic area participated in 17% as well. The covering mucosa of the stomach above the heterotopic nests wes affected with varieties of chronic gastritis in 88.3%, and of those, chronic atrophic (hyperplastic) gastritis prevailed(69.1%). Disruption of muscularis mucosae above the heteropotic nests was demonstrated in 43.5%, to leave sufficient size of gaps through which herniation of reconstructed mucosa occurred. The association rate of heterotopia to gastric reflecting no specific relation to gastric carcinogenesis. Similarity of histotopographic pattern and composition between submucosal epithelial heterotopia and gastritis cystica profunda may lead to a concept that each represents a different stage of the same disease spectrum. The above findings strongly support that submucosal epithelial heterotopia is a product of an acquired gastric mucosal alteration, especially of chronic atrophic gastritis and secondary disruption of muscularis mucosae, through which the modified mucosa by gastritic reconstruction(Umbau) herniates into the underlying submucosa. It seems also a basic pathogenesis of gastritis cystica profunda that the compromised excretory pathway and mucous retention lead to subsequent cystic dilatation of submucosal epithelial nests.
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