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Review
. 2024 Oct-Dec;65(4):593-598.
doi: 10.47162/RJME.65.4.05.

Adenocarcinoma of the ileum: literature insights on pyloric gland metaplasia

Bogdan Stancu  1 , Răzvan Alexandru Ciocan, Marius George Teodorescu, Doiniţa Crişan, Florin Vasile Mihăileanu, Ştefan Ursu, Liviu Tartacovschi, Ştefan Lucian Popa, Claudia Diana Gherman, Octavian Aurel Andercou
Affiliations
Review

Adenocarcinoma of the ileum: literature insights on pyloric gland metaplasia

Bogdan Stancu et al. Rom J Morphol Embryol. 2024 Oct-Dec.

Abstract

Adenocarcinoma (ADK) of the ileum is an infrequent cancer that poses significant diagnostic and treatment difficulties. This article analyses the existing case literature to investigate the correlation between pyloric gland metaplasia (PGM) and the onset of ileal ADK. PGM, defined by the atypical transformation of intestinal epithelial cells into gastric-type mucosa, has been recognized as a possible precursor lesion in the spectrum of several gastrointestinal malignancies. We intend to clarify the clinical characteristics, histological results, and outcomes linked to ileal ADK originating from PGM through an exhaustive examination of recorded cases. Our findings indicate that early identification of metaplastic alterations may be essential for enhancing prognosis and informing therapeutic choices. This study emphasizes the need for additional research to elucidate the mechanisms driving this transition and to improve diagnostic precision in clinical practice.

Keywords: adenocarcinoma; gastrointestinal cancer; histology; ileum; precursors; pyloric gland metaplasia.

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Conflict of interest statement

The authors have no conflict of interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram for the selected studies included in the systematic review (records identified from PubMed, Embase and Web of Science–Clarivate Analytics databases). PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses
Figure 2
Figure 2
Macroscopic appearance of the distal ileum. Markedly thickened mucosal folds (arrow) situated adjacent to the tumor (not depicted) in comparison to the normal ileal mucosa (arrowhead)
Figure 3
Figure 3
Histopathological findings of the ileal mass: (A) Epithelial malignant proliferation displaying tubular and papillary morphology; (B) Photomicrograph showing solid growth areas within the same tumor; the adenocarcinomatous infiltration is apparent in the muscularis propria (serosal adipose tissue extension not depicted). HE staining: (A) ×100; (B) ×40. HE: Hematoxylin–Eosin
Figure 4
Figure 4
Microscopic aspect of the peritumoral ileal mucosa: (A) Multiple foci of pyloric gland metaplasia abutting the muscularis mucosae; (B) Pyloric-type glands stained with PAS, in contrast to the AB affinity of the adjacent intestinal glands. HE staining: (A) ×100. PAS–AB staining: (B) ×100. AB: Alcian Blue; HE: Hematoxylin–Eosin; PAS: Periodic Acid–Schiff.
Figure 5
Figure 5
Immunoreactivity for CK7: (A) The tumor showed a strong, diffuse reaction for CK7; (B) The adjacent intestinal mucosa was weakly and patchy positive for the same marker. Anti-CK7 antibody immunomarking: (A) ×40; (B) ×100. CK7: Cytokeratin 7.
Figure 6
Figure 6
Immunohistochemical study with CK20: (A) The malignant epithelial component was negative for CK20; (B) The adjacent intestinal mucosa was strongly positive for the same marker (left, center). Anti-CK20 antibody immunomarking: (A) ×40; (B) ×100. CK20: Cytokeratin 20
Figure 7
Figure 7
HER2 oncoprotein overexpression. The tumor depicted a strong (3+) expression (right). Anti-HER2 antibody immunomarking, ×200. HER2: Human epidermal growth factor receptor 2
See this image and copyright information in PMC

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