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[Heterotopic gastric mucosa in the gastric submucosa]

[2014-9-1. 애독자 질문] 내시경 책을 보다가 궁금점이 생겨서 문의드립니다. 첨부한 사진에도 나오지만 위내 점막하종양인데 이소성 위점막이라는 말을 할 수 있는 건가요? ^^;; 위외의 다른 장기에 있을때 이소성 위점막이라는 용어를 쓸것같은데... 폰으로 찍은 사진이라 화질이 나쁘네요. 죄송합니다.

[2014-9-2. 이준행 답변] 좋은 질문입니다. Heterotopic gastric mucosa in the esophagus 혹은 heterotopic gastric mucosa in the duodenum은 들어보셨을 것입니다. 그런데 heterotopic gastric mucosa in the stomach이라는 것도 있습니다. 위점막이 위점막하층에 위치하는 경우입니다. 당연히 점막하종양처럼 보입니다. 일전에 삼성서울병원에서 heterotopic gastric mucosa에서 시작한 위암 2예를 보고한 적도 있습니다. 그 증례보고의 discussion 부분을 옮깁니다.

Heterotopic gastric mucosa in the gastric submucosa is reported to occur in 3.0 to 20.1% of resected stomach specimens. Although the etiology of this disease is unknown, mucosal infoldings bulging in the submucosal tissue have been demonstrated, probably as a result of inflammation or ulceration. In addition, the histologic characteristics of heterotopic gastric mucosa with cystic expansion are very similar to gastritis cystic polyposa, but gastritis cystric polyposa is known to occur at anastromotic sites after gastrectomy. Heterotopic gastric mucosa is thought to occur due to infiltration of mucosa through muscularis mucosa cracks or defects by repeated erosion. While heterotopic gastric mucosa occurs due to movement of gastric mucosa to the submucosa through the muscularis mucosa of weak resistance, the muscularis mucosa of heterotopic gastric mucosa is connected with normally located muscularis mucosa, and such a characteristic suggests that it is a true mucosal diverticuli. Although it has not clearly been determined if heterotopic gastric mucosa is due to congenital or acquired causes, heterotopic gastric mucosa is found in 20.1% of gastric specimens from adults, but not in gastric specimens from children, thus it is thought to occur by acquired causes. Because heterotopic gastric mucosa is found primarily among adults in their 60s and is not found in autopsies of people <20 years of age, it is presumed to be due to repetitive inflammation.