Pyloric gland adenoma: a clinico-pathological analysis of 90 cases

Abstract

Background: Pyloric gland adenoma is a rarely described neoplasia of the gastric mucosa. Recent publications have shown that similar lesions are also found in the gallbladder, the main pancreatic duct, the duodenum and the cervix of the uterus. Apart from case reports, few clinical data are available on these patients. We therefore conducted a search of the archived material collected between 1990 and 2000 for more clinical data on patients with this rare lesion. Patients and methods: Between 1990 and 2000, 90 patients were diagnosed as having a pyloric gland adenoma in the stomach (77 patients), duodenal bulb (7 patients), duodenum (1 patient), bile duct (3 patients) or gallbladder (2 patients). Results: Pyloric gland adenomas account for 2.7% of all gastric polyps and occur predominantly in old age (73€12.8 years), more frequently in women (75%) than in men. The predilection site in the stomach is the corpus mucosa (64%) and they are often found in patients suffering from autoimmune gastritis (36%). At the time of diagnosis, pyloric gland adenomas measure 16.1€9.1 mm in size. In 30% of gastric pyloric adenomas, transition to well-differentiated adenocarcinoma has been noted. Discussion: In our material, pyloric gland adenoma is the third most common neoplastic polypoid lesion in the stomach. Since a search through the literature revealed only a few case reports on this lesion, it is possible that for some reason this lesion might be diagnosed more often than reported. Conclusion: Our study revealed that 30% of the gastric pyloric gland adenomas showed continuous transition to well-differentiated adenocarcinoma at the time of the initial diagnosis. This underscores the malignant potential of the lesion, and the need for polypectomy.

Upper GI Tract Lesions in Familial Adenomatous Polyposis (FAP)

“…These lesions were fully characterized in 2003 by Vieth et al 19 and confirmed by our group. 18 As most histologic studies of upper tract lesions in FAP patients were published before the recognition of PGAs, these lesions were presumably classified as other types of polyps in previous reports.…”

“…These polyps show a preference for the gastric body, and gastric examples show a remarkable female predominance. This female predominance occurs because many PGAs arise in patients with autoimmune metaplastic atrophic gastritis, 18,19 which characteristically has ample pyloric metaplasia. In one study of gastric polyps in 461 patients with autoimmune gastritis, 143 patients had endoscopically identifiable lesions.…”

Morphology and genetics of pyloric gland adenomas in familial adenomatous polyposis

“…Unfortunately, a direct morphological comparison of sporadic and FAP associated PGAs could not be performed. However, it is felt that our group is well equipped to compare our findings in PGAs in FAP to the existing literature on sporadic pyloric and oxyntic gland adenomas since several authors of the current study significantly contributed to this field 1, 3–5, 9, 15, 17, 18 . Unfortunately previous studies on PGAs in FAP did provide extensive morphological assessment of these polyps 3, 7 …”

Patients with McCune-Albright syndrome have a broad spectrum of abnormalities in the gastrointestinal tract and pancreas

“…Pyloric gland adenomas consist of proliferations of closely packed tubules, each lined by a monolayer of round basally oriented nuclei with apically oriented eosinophilic ground glass cytoplasm [19–21 ]. They are most commonly detected in the stomach, where they are likely to arise in patients with autoimmune gastritis.…”