Gastric Pyloric Gland Adenoma: A Multicenter Clinicopathologic Study of 67 Cases

Abstract

Aims

There is limited information regarding the clinicopathologic and immunohistochemical characteristics of gastric pyloric gland adenomas (PGAs).

Methods and Results

Sixty seven cases of gastric PGA from 57 patients were analyzed. PGAs occurred with similar frequency in men and women (47.4% and 52.6%, respectively) with a mean age of 66 years. Most presented in the gastric body/fundus (67.2%). Fifteen cases (22.4%) developed in a background of autoimmune gastritis (AIG), whereas normal mucosa was seen in 35.8%. Only 16.4% (11 cases) developed in patients with a genetic predisposition, most commonly familial adenomatous polyposis. Low-grade lesions had a mean size of 1.5 cm, while PGAs with high-grade dysplasia (HGD) or adenocarcinoma had a mean size of 3.5 cm (p < 0.001) and more commonly showed tubulovillous architecture (50.0% versus 25.6% in low-grade dysplasia; p = 0.040). Most PGAs (61.2%) co-expressed MUC5AC and MUC6 (mixed type), which was significantly associated with HGD or adenocarcinoma (p = 0.013). AIG was also associated with HGD (p = 0.027), but genetic predisposition did not correlate with the grade of dysplasia (p = 0.793). The recurrence rate of PGA was similar for high- (11.8%) and low-grade lesions (7.4%) (p = 0.624).

Conclusions

The risk of HGD increases with the size of PGA, tubulovillous architecture, and the presence of AIG as well as mixed immunophenotype. Since the overall local recurrence rate is less than 10%, PGAs may be treated conservatively, but they should be completely excised if possible, particularly if they are large or show high-grade features.

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