Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2380
Peer-review started: February 6, 2020
First decision: April 14, 2020
Revised: April 23, 2020
Accepted: May 14, 2020
Article in press: May 14, 2020
Published online: June 6, 2020
Pyloric gland adenoma (PGA) is a recently described and rare tumor. Submucosal tumor (SMT)-like PGA is more difficult to diagnose and differentiate from other submucosal lesions.
We present the case of a 69-year-old man with a 10 mm SMT-like elevated lesion with an opening in the upper part of the gastric body, referred to our hospital for further endoscopic treatment. Magnifying endoscopy with narrow-band imaging, endoscopic ultrasonography, and complete endoscopic submucosal dissection were performed on the patient. Histopathological findings revealed tightly packed tubular glands lined with cuboidal or columnar cells that had round-to-oval nuclei containing occasional prominent nucleoli and an eosinophilic cytoplasm similar to that in non-neoplastic gastric pyloric glands. Additionally, immunohistochemical analysis showed positive staining for both mucin 5AC and mucin 6. Therefore, we arrived at the final diagnosis of gastric PGA. Although there was no apparent malignant component in this tumor, PGA has been considered a precancerous disease with a high risk of transformation into adenocarcinoma.
PGA should be considered when detecting gastric SMT-like lesions. Physicians and pathologists should focus on PGA due to its malignant potential.
Core tip: Pyloric gland adenoma continues to be a rare neoplasm of the stomach. We report a case where upper gastrointestinal endoscopy revealed a 10 mm submucosal tumor-like elevated lesion located in the upper part of the gastric body. Preoperative diagnosis is difficult because of the generally deep location of the tumor. Endoscopic ultrasound and endoscopic submucosal dissection were performed in this patient. The histopathological and immunohistochemistry investigations resulted in the diagnosis of pyloric gland adenoma.