Won-Tak Choi1, Ian Brown2, Tetsuo Ushiku3, Masato Yozu4, Namrata Setia5, Amitabh Srivastava6, Melanie Johncilla6, Rish K Pai7, Ryan M Gill1, Masashi Fukayama3, Joseph Misdraji4, Gregory Y Lauwers8. 1. Department of Pathology, University of California at San Francisco, San Francisco, CA, USA. 2. Envoi Pathology, Kelvin Grove, Brisbane, Qld, Australia. 3. Department of Pathology, University of Tokyo, Tokyo, Japan. 4. Department of Pathology, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Pathology, University of Chicago, Chicago, IL, USA. 6. Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA. 7. Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA. 8. Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
Abstract
AIMS: There is limited information regarding the clinicopathological and immunohistochemical characteristics of gastric pyloric gland adenomas (PGAs). METHODS AND RESULTS: Sixty-seven cases of gastric PGA from 57 patients were analysed. 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 against 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 mucin (MUC)5AC and MUC6 (mixed type), which was associated significantly 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. As the overall local recurrence rate is less than 10%, PGAs may be treated conservatively, but they should be excised completely if possible, particularly if they are large or show high-grade features.
AIMS: There is limited information regarding the clinicopathological and immunohistochemical characteristics of gastric pyloric gland adenomas (PGAs). METHODS AND RESULTS: Sixty-seven cases of gastric PGA from 57 patients were analysed. 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 against 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 mucin (MUC)5AC and MUC6 (mixed type), which was associated significantly 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. As the overall local recurrence rate is less than 10%, PGAs may be treated conservatively, but they should be excised completely if possible, particularly if they are large or show high-grade features.
Authors: Camilla Guerini; Marco Vincenzo Lenti; Chiara Rossi; Giovanni Arpa; Andrea Peri; Anna Gallotti; Antonio Di Sabatino; Alessandro Vanoli Journal: Front Med (Lausanne) Date: 2022-05-19
Authors: Hai-Long Li; Yan Wang; Yu-Bo Ren; Xue-Song Yang; Li Wang; Lei Zhang; Xiang-Chun Lin Journal: Medicine (Baltimore) Date: 2021-06-25 Impact factor: 1.889