Gastric Pyloric Gland Adenoma: A Case Report, Review of Literature, and Diagnostic Challenges in the Philippine Setting

Kevin Elomina, Ignacio de Guzman Jr.

Abstract

Pyloric gland adenoma (PGA) is a rare neoplasm with definite malignant potential that is difficult to recognize because of its characteristically bland histology. We present a case of a 74-year old female with chronic, intermittent symptoms referable to gastroesophageal reflux, bloatedness, and frequent flatus, with family history of gastric cancer. Initial endoscopy was done and biopsy revealed an inflammatory pseudopolyp. After six months, repeat endoscopy showed multiple polyps at the cardia, and biopsy of one of the visualized polyps was done. Microscopic sections of the polyp show a neoplasm composed of discrete glands lined by simple cuboidal to columnar epithelial cells with amphophilic to eosinophilic cytoplasm without apical mucin caps, and mild nuclear atypia. Mild epithelial stratification is noted in some of the glands. PAS staining showed granular, cytoplasmic staining in tumor cells. Immunohistochemical staining with P53 showed focal, weak, nuclear staining in tumor cells. Staining with Ki67, MUC2, MUC5AC, and MUC6 were not done because the tissue had already been exhausted. The diagnosis of PGA with low-grade dysplasia has been made. The patient is apparently well, and is advised surveillance endoscopy at six-month intervals. PGA may be diagnosed in a limited resource setting, through thorough histologic examination, and use of special histochemical stains.

Keywords

Pyloric gland adenoma, P53, Ki-67, GNAS, KRAS

Full Text:

Abstract HTML

References

Lauwers GY, Carneiro F, Graham DY, Curado M-P, Franceschi S, Montgomery E, et al. Gastric carcinoma. In: Bosman FT, Jaffe ES, Lakhani SR, Ohgaki H, editors. WHO Classification of Tumors of the Digestive System. 4th ed. Lyon, France: International Agency for Research on Cancer; 2010.

Choi WT, Brown I, Ushiku T, et al. Gastric pyloric gland adenoma: a multicenter clinicopathologic study of 67 cases. Histopathology. 2018;72(6):1007–14. PMID: 29278427. https://doi.org/10.1111/his.13460.

Lee SE, Kang SY, Cho J, et al. Pyloric gland adenoma in Lynch syndrome. Am J Surg Pathol. 2014;38(6):784–92. PMID: 24518125 PMCID: PMC4014525. htpps://doi.org/10.1097/PAS.0000000000000185.

Cakar E, Bayrak S, Paşaoğlu E, Colak S, Bektaş H, Güneyi A. Pyloric gland adenoma: a case report. Case Rep Gastroenterol. 2013;7(3):392–5. PMID: 24163651. PMCID: PMC3806671. https://doi.org/10.1159/000355342.

Chlumská A, Waloschek T, Mukenšnabl P, Martínek P, Kašpírková J, Zámečník M. Pyloric gland adenoma: a histologic, immunohistochemical and molecular genetic study of 23 cases. Cesk Patol. 2015;(3):137–43. PMID: 26421956.

Vieth M, Montgomery EA. Some observations on pyloric gland adenoma: an uncommon and long ignored entity! J Clin Pathol. 2014;67(10):883–90. PMID: 25092673. https://doi.org/10.1136/jclinpath-2014-202553.

Pezhouh MK, Park JY. Gastric pyloric gland adenoma. Arch Pathol Lab Med. 2015;139(6):823–6. PMID: 26030253. https://doi.org/10.5858/arpa.2013-0613-RS.

Chen ZM, Scudiere JR, Abraham SC, Montgomery E. Pyloric gland adenoma: an entity distinct from gastric foveolar type adenoma. Am J Surg Pathol. 2009;33(2):186–93. PMID: 18830123. https://doi.org/ 10.1097/PAS.0b013e31817d7ff4.

Refbacks

  • There are currently no refbacks.