Gastric pyloric gland adenoma: a multicentre clinicopathological study of 67 cases

Choi, Wookap; Brown, Ian; Ushiku, Tetsuo; Yozu, Masato; Setia, Namrata; Srivastava, Amitabh; Johncilla, Melanie; Pai, Rish K.; Gill, Ryan M.; Fukayama, Masashi; Misdraji, Joseph; Lauwers, Gregory Y.

doi:10.1111/his.13460

Cited by 41 publications

(84 citation statements)

References 21 publications

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“…In our series of 57 duodenal PGA we have shown that they typically arise in the proximal duodenum in older individuals, a minority of whom have adjacent gastric heterotopia. Larger lesions and those showing villous architecture within the lesion were more likely to harbour areas of high‐grade dysplasia or invasive malignancy, similar to the features of high‐grade lesions within the stomach …”

Section: Discussionmentioning

confidence: 89%

“…Twenty‐seven had sufficient tissue to perform additional IHC stains for intestinal markers MUC2, CDX2 and CD10. The histological features of the PGA analysed were the architectural growth pattern and grade of dysplasia, as previously described . In short, architecture was broadly classified into cases with predominantly tubular growth or those with both tubular and villous (tubulovillous) growth patterns.…”

Section: Methodsmentioning

confidence: 99%

“…Using immunohistochemistry (IHC), PGA stain with the gastric mucin (MUC)6. By definition, all lesions show at least low‐grade architectural and cytological dysplasia, while high‐grade dysplastic lesions show architectural changes of cribriform or back‐to‐back glands with cytological features of nuclear enlargement, crowding, prominent nucleoli and hyperchromasia . Historical data report that between 10.5% and 66.6% of duodenal PGA harbour an associated invasive adenocarcinoma .…”

Section: Introductionmentioning

confidence: 99%

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Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

et al. 2019

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Aims To determine the clinicopathological features of pyloric gland adenomas (PGA) that arise in the duodenum. Methods and results Fifty‐seven cases of duodenal PGA were identified and analysed from 56 patients. Clinicopathological and immunohistochemical analyses were performed. PGA tend to occur in older individuals (median age = 73.5), with a slight female predominance (25 males, 31 females). PGA arise more commonly in the proximal duodenum (68.75% in D1, 25% in D2 and 6.25% in D3) and usually present as mucosal nodules (98.2%) or plaques (1.8%), with a mean size of 14.8 mm. There is associated gastric heterotopia in 22.8% of cases. PGA showing features of high‐grade dysplasia were significantly larger in size than PGA, showing only low‐grade dysplasia (23.1 versus 8.7 mm; P = 0.0001) and more likely to show a tubulovillous rather than a pure tubular architecture (P = 0.025). In our series, 10 of 56 patients had intramucosal or invasive carcinoma associated with the duodenal PGA (17.9%). Three of these carcinomas showed lymph node metastasis. Following definitive treatment, local recurrence occurred in only three patients. Conclusions Duodenal PGA tend to occur in the proximal duodenum of older individuals. Larger size and tubulovillous architecture correlates with high‐grade dysplasia and associated adenocarcinoma. The low recurrence rate of these lesions would suggest that endoscopic management is appropriate, provided that the lesion can be completely resected.

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Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

et al. 2019

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“…In previous studies of gastric adenoma and adenocarcinoma, low-grade adenoma/dysplasia showed stable intestinal phenotype and high-grade adenoma/dysplasia showed unstable gastric or mixed gastric and intestinal phenotype. 12,13 Furthermore, mixed immunophenotype of MU5AC and MUC6 has recently been demonstrated in HGD than in LGD of pyloric gland adenomas, 14 and the positive immunoreactivity of MUC6 is suggested to be a risk factor for malignant change. 15 Taken together, mixed immunophenotype may indicate unstableness and malignant potential of HGD.…”

Section: Discussionmentioning

confidence: 99%

No transformation of a fundic gland polyp with dysplasia into invasive carcinoma after 14 years of follow‐up in a proton pump inhibitor‐treated patient: A case report

Fukuda

Ishigaki

Ban

et al. 2018

Pathology International

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A fundic gland polyp (FGP) is a common gastric polyp. Intraepithelial neoplasia in FGPs, referred to as FGP with dysplasia, is often seen in patients with familial adenomatous polyposis (FAP). In sporadic FGPs, low‐grade dysplasia (LGD) is rare, and high‐grade dysplasia (HGD) or carcinoma arising from sporadic FGPs is extremely rare. Because of this rarity, the prognosis and appropriate management of these lesions have not been clarified. In the present case, a sporadic FGP with LGD did not develop into invasive carcinoma, but contained foci of HGD 14 years after diagnosis. The biopsy specimen of the polyp taken at the first esophagogastroduodenoscopy 15 years earlier was diagnosed as FGP without dysplasia. At the second histological examination, LGD was found. Because the polyp increased in size during proton pump inhibitor therapy for 14 years, endoscopic mucosal resection was performed. The pathological diagnosis of the resected specimen was FGP with HGD mixed in LGD, with no invasive carcinoma. Dysplasia in FGPs might have less malignant potential regardless of dysplasia or size.

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“…Foveolar (17%) and pyloric gland type (3%) adenomas are more common in FAP than conventional adenomas. 25 Endoscopic management of these polyps, even those with superficial submucosal invasion, is usually adequate and gastrectomy is reserved for deeply infiltrating carcinomas.…”

Section: Familial Adenomatous Polyposis (Fap)mentioning

confidence: 99%

Adenomatous and serrated polyposis syndromes

Srivastava

2020

Diagnostic Histopathology

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Gastric pyloric gland adenoma: a multicentre clinicopathological study of 67 cases

Cited by 41 publications

References 21 publications

Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

No transformation of a fundic gland polyp with dysplasia into invasive carcinoma after 14 years of follow‐up in a proton pump inhibitor‐treated patient: A case report

Adenomatous and serrated polyposis syndromes

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