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Case Reports
. 2023 Dec 21;10(12):e01229.
doi: 10.14309/crj.0000000000001229. eCollection 2023 Dec.

Pyloric Gastric Adenoma: Endoscopic Detection, Removal, and Echoendosonographic Characterization

Anabel Liyen Cartelle  1 , Erik A Holzwanger  2 , Samuel Igbinedion  2 , Sultan Mahmood  2 , Harry J Rosenberg  3 , Tyler M Berzin  2 , Mandeep S Sawhney  2 , Moamen Gabr  2 , Douglas K Pleskow  2
Affiliations
Case Reports

Pyloric Gastric Adenoma: Endoscopic Detection, Removal, and Echoendosonographic Characterization

Anabel Liyen Cartelle et al. ACG Case Rep J. .

Abstract

Pyloric gland adenomas (PGAs) are rare neoplasms found not only in the gastrointestinal tract but also in other extragastrointestinal organs. They have potential for malignant conversion, and early detection and removal is imperative to prevent invasive disease. PGAs prove difficult in management and surveillance given their rarity. However, increasing familiarity with histological appearance and use of advanced tools such as echoendosonography can bring greater understanding of their clinical history. We describe a unique case of a PGA detected within a hiatal hernia sac characterized with echoendosonography and highlight the need to develop surveillance protocols for these types of lesions.

Keywords: echoendosonography; gastric polyps; pyloric gland adenoma; surveillance.

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Figures

Figure 1.
Figure 1.
Upper endoscopy view of the pyloric gland adenomas found within the hiatal hernia on the gastric side of the gastroesophageal junction.
Figure 2.
Figure 2.
Endoscopic ultrasound (radial 10 mHz) image taken at the region of the polyp before excision revealing a thickened esophageal wall but no clear mucosal/submucosal lesion.
Figure 3.
Figure 3.
(A) A low-power view of the polyp shows a polypoid fragment of stomach mucosal epithelium with glandular proliferation. (B) A high-power view of the interior of the polyp shows back-to-back mucinous tubular glands surrounded by a monolayer of small round nuclei without noticeable atypia, consistent with a pyloric adenoma. Although many pyloric adenomas can have dysplastic features, such as cribriform formation, with nuclear crowding, nuclear enlargement, loss of nuclear polarity, enlarged nucleoli, and/or hyperchromasia, this polyp did not. Yellow arrow points to back-to-back mucinous glands.
See this image and copyright information in PMC

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