pyloric gland adenoma of the stomach

Images

 https://twitter.com/ARP_Press/status/731848173266862081

For Pyloric gland adenomas, some of the features included tubules or glands with arrangements as monolayers of cuboidal to low columnar epithelial cells without apical neutral mucin caps.

The nuclei were round-to-oval with a pale amphophilic-to-eosinophilic ground-glass textured cytoplasm.

PGAs are a rare neoplasm of the gastric epithelium which has been frequently associated with AMAG.

PGA was briefly mentioned in the 1990 World Health Organization classification of esophageal and gastric tumors but interest in the entity remained dormant until 2003 when Vieth and his colleagues reported a large series of such lesions.

PGAs may also arise in a host of other sites; for example, in our earlier series they were more common in the small intestine than in the stomach.

PGAs may be cytologically bland without conventional adenomatous dysplasia.

Predisposition

 familial adenomatous polyposis (FAP) (6%) (24525509)
 Lynch syndrome (MMR) (24518125)
 autoimmune gastritis

• Review of archived cases from patients with well-characterized autoimmune gastritis (using immunolabeling for gastrin and chromogranin) only revealed a single case of PGA that was not recognized at the original time of diagnosis.
• There were a total of 3 cases of PGAs identified in this 20-year study of autoimmune gastritis in a high-volume hospital’s “in-house” material.
• This paucity of cases is unexpected and somewhat disappointing as prior studies of PGAs indicated a strong association with a background of AMAG.
• Indeed, if a PGA arising out of AMAG had been previously classified as an intestinal-type gastric adenoma, and no material was available to characterize the background of AMAG, then it would not have been included in this study.
• In the cases diagnosed with a background of AMAG, PGA is a rare entity.

Open References

 Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms. Wood LD, Salaria SN, Cruise MW, Giardiello FM, Montgomery EA. Am J Surg Pathol. 2014 Mar;38(3):389-93. doi : 10.1097/PAS.0000000000000146 PMID: 24525509 [Free]

 Pyloric gland adenoma in Lynch syndrome. Lee SE, Kang SY, Cho J, Lee B, Chang DK, Woo H, Kim JW, Park HY, Do IG, Kim YE, Kushima R, Lauwers GY, Park CK, Kim KM. Am J Surg Pathol. 2014 Jun;38(6):784-92. doi : 10.1097/PAS.0000000000000185 PMID: 24518125 [Free]

References

 Gastric lesions in patients with autoimmune metaplastic atrophic gastritis (AMAG) in a tertiary care setting. Park JY, Cornish TC, Lam-Himlin D, Shi C, Montgomery E. Am J Surg Pathol. 2010 Nov;34(11):1591-8. PMID: 20975338