Pyloric gland adenoma with low-grade intraepithelial neoplasia: A case report and literature review

Abstract

Rationale: Pyloric gland adenoma (PGA) is often associated with pyloric gland metaplasia. It has high malignant potential but a low clinical diagnosis rate. Therefore, we reported a case of PGA and reviewed the literature to summarize the clinicopathological features of pyloric adenoma.

Patient concerns: A 62-year-old female underwent gastroscopy due to intermittent acid regurgitation and heartburn, which revealed a 4×6 mm flat, elevated lesion in the greater curvature of the upper gastric body, with depression in the central region and blood scab attachment.

Diagnosis and intervention: Biopsy revealed gastric adenoma with low-grade intraepithelial neoplasia. The patient was treated with ESD, and pathology showed gastric pyloric gland adenoma with low-grade dysplasia. The cells were positive for MUC6 and MUC5AC immunohistochemically.

Outcomes: The patient received proton pump inhibitors and gastric mucosal protective agents for one month after ESD. She occasionally presented acid regurgitation and heartburn, with no abdominal pain, abdominal distension, melena, or hematochezia. Follow-up gastroscopy will be reexamined 1 year later.

Lessons: PGA has nonspecific performance under endoscopy, and its diagnosis mainly depends on pathology. Clinicians need to increase their ability to recognize such lesions and treat them in time to improve the prognosis.

Figure 1

(A) The lesion was located in the great curvature of the upper segment of the gastric body, as shown by the arrow. (B) Observation showed that the lesion was type IIa, colorless change, old blood could be seen at the central depression, and the lesion size was 4×6 mm in size. In FICE mode image (C), the demarcation line of the lesion was positive, and the surface pattern was dense and slightly disordered.

Figure 2

Pathological images showing PGA with low-grade intraepithelial neoplasia (A) (100×); (B) (200×). HE staining showed dense tubular glands covered with monolayer cuboidal to low columnar epithelial cells, mild structural disorder, slightly elongated nuclei, no obvious nucleoli, light staining to eosinophilic cytoplasm, ground glass shape, and no apical mucinous cap. (C–F) Immunohistochemistry. (C) (100×) Ki67 positivity of less than 1%. (D) (100×) MUC2 negative. (E) (100×) MUC5AC positive. (F) (100×) MUC6 positive.