In a 46-year-old man, a pedunculated rectal polyp measuring 3.0x3.0x2.0 cm was diagnosed histologically as a pyloric gland-type adenoma arising in heterotopic gastric corpus mucosa. The luminal site was covered by glands of the gastric foveolar type, displaying focal marked proliferation interpreted as low-grade intraepithelial neoplasia. A bidirectional gastric differentiation was found: most lower glandular structures showed positivity for the deep gastric mucin core protein Muc 6 and superficial positivity for gastric foveolar epithelium mucin core protein Muc 5AC. Pyloric gland adenoma has so far been described in one larger series only and a few case reports of the stomach, gallbladder, pancreatic duct and within heterotopic gastric corpus mucosa of the duodenal bulb. The present case report is the first case of a pyloric gland-type adenoma within a gastric corpus heterotopia of the rectal mucosa.

We report the case of a 49-year-old patient with progressive sensomotor polyneuropathy who developed nausea, vomiting, and diarrhea after 2 1/2 months of azathioprine therapy. Administration of the drug was interrupted. These symptoms recurred immediately after rechallenge with azathioprine. A duodenal biopsy demonstrated a massive local eosinophilia without peripheral blood eosinophilia. Cutane testing with azathioprine showed a positive type 1 reaction. We diagnosed a hypersensitive reaction type 1 in the duodenal mucosa on the basis of the histological features, the history, and the cutane reaction.

No abstract