Virchows Archiv

, Volume 446, Issue 5, pp 542–545 | Cite as

Adenoma with gastric differentiation (so-called pyloric gland adenoma) in a heterotopic gastric corpus mucosa in the rectum

  • M. Vieth
  • R. Kushima
  • J. P. A. de Jonge
  • F. Borchard
  • F. Oellig
  • M. Stolte
Case Report

Abstract

In a 46-year-old man, a pedunculated rectal polyp measuring 3.0×3.0×2.0 cm was diagnosed histologically as a pyloric gland-type adenoma arising in heterotopic gastric corpus mucosa. The luminal site was covered by glands of the gastric foveolar type, displaying focal marked proliferation interpreted as low-grade intraepithelial neoplasia. A bidirectional gastric differentiation was found: most lower glandular structures showed positivity for the deep gastric mucin core protein Muc 6 and superficial positivity for gastric foveolar epithelium mucin core protein Muc 5AC. Pyloric gland adenoma has so far been described in one larger series only and a few case reports of the stomach, gallbladder, pancreatic duct and within heterotopic gastric corpus mucosa of the duodenal bulb. The present case report is the first case of a pyloric gland-type adenoma within a gastric corpus heterotopia of the rectal mucosa.

Keywords

Pyloric-gland adenoma Rectum polyp Heterotopic gastric mucosa 

References

  1. 1.
    Amaris J (2002) Intraductal mucinous papillary tumor and pyloric gland adenoma of the pancreas. Gastrointest Endosc 56:441–444Google Scholar
  2. 2.
    Antonietta Pistoia M, Guadagni S, Ventura T, Pistoia F, Carboni M (1986) Gastric heterotopia of the rectum. Endoscopy 18:34Google Scholar
  3. 3.
    Bakotic BW, Robinson MJ, Sturm PD, Hruban RH, Offerhaus GJ, Albores–Saavedra J (1999) Pyloric gland adenoma of the main pancreatic duct. Am J Surg Pathol 23:227–231Google Scholar
  4. 4.
    Beck F, Chawengsaksophak K, Waring P, Playford RJ, Furness JB (1999) Reprogramming of intestinal differentiation and intercalary regeneration in Cdx2 mutant mice. Proc Natl Acad Sci U S A 96:7318–7323Google Scholar
  5. 5.
    Borchard F, Ghanei A, Koldovsky U, Hengels KJ, Bückmann FW (1990) Gastrale Differenzierung in Adenomen der Magenschleimhaut. Immunhistochemische und elektronenmikroskopische Untersuchungen. Verh Dtsch Ges Pathol 74:523Google Scholar
  6. 6.
    Borchard F, Bodensieck U, Koldovsky U (1993) Entwicklung des monoklonalen Antikörpers R3C4 gegen das foveoläre Muzin M1. Verh Dtsch Ges Pathol 74:523Google Scholar
  7. 7.
    Devereaux CE, Devereaux RG (1994) Heterotopic gastric mucosa of the rectum with a review of the literature. J Clin Gastroenterol 19:41–45Google Scholar
  8. 8.
    Elster K (1976) In: Morson BC (ed) Current topics in pathology 63. Springer, Berlin Heidelberg New York, p 86Google Scholar
  9. 9.
    Fenoglio–Preisser CM (1999) Gastrointestinal pathology. Lippincott–Raven, PhiladelphiaGoogle Scholar
  10. 10.
    Hanisch FG, Koldovsky U, Borchard F (1993) Monoclonal antibody 2B5 defines a truncated O-glycan, GlcNAc beta 1–3Gal beta 1–4GlcNAc beta 1–6 (GalNAc), on mucins from deep gastric and duodenal glands as well as metaplasia and neoplasia of gastric differentiation. Cancer Res 53:4791–4796Google Scholar
  11. 11.
    Mukaisho K, Miwa K, Kumagai H, Bamba M, Sugihara H, Hattori T (2003) Gastric carcinogenesis by duodenal reflux through gut regenerative cell lineage. Dig Dis Sci 48:2153–2158Google Scholar
  12. 12.
    Kato N, Akiyama S, Motoyama T (2002) Pyloric gland-type tubular adenoma superimposed on intraductal papillary mucinous tumor of the pancreas. Pyloric gland adenoma of the pancreas. Virchows Arch 440:205–208Google Scholar
  13. 13.
    Kato Y, Sugano H, Rubio CA (1983) Classification of intramucosal cysts of the stomach. Histopathology 7:931–938Google Scholar
  14. 14.
    Kestemberg A, Marino G, de Lima E, Garcia FT, Carrascal E, Arredondo JL (1993) Gastric heterotopic mucosa in the rectum with Helicobacter pylori-like organisms: a rare cause of rectal bleeding. Int J Colorectal Dis 8:9–12Google Scholar
  15. 15.
    Kushima R, Remmele W, Stolte M, Borchard F (1996) Pyloric gland type adenoma of the gallbladder with squamoid spindle cell metaplasia. Pathol Res Pract 192:963–969Google Scholar
  16. 16.
    Kushima R, Ruthlein HJ, Stolte M, Bamba M, Hattori T, Borchard F (1999) “Pyloric gland-type adenoma” arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type. Virchows Arch 435:452–457Google Scholar
  17. 17.
    Laitio M (1975) Goblet cells, enterochromaffin cells, superficial gastric-type epithelium and antral-type glands in the gallbladder. Beitr Pathol 156:343–358Google Scholar
  18. 18.
    Levine DS (1987) “Solitary” rectal ulcer syndrome. Are “solitary” rectal ulcer syndrome and “localized” colitis cystica profunda analogous syndromes caused by rectal prolapse? Gastroenterology 92:243–253Google Scholar
  19. 19.
    Lewin KJ, Riddell RH, Weinstein WM (1992) Gastrointestinal pathology and its clinical implications. Igaku–Shoin, New YorkGoogle Scholar
  20. 20.
    Lohe B, Ghanei A, Koldovsky U, Borchard F (1990) Gastrale Differenzierung in Neoplasien der Gallenblase–Untersuchungen mit dem monoklonalen Antikörper 2B5. Verh Dtsch Ges Pathol 74:529Google Scholar
  21. 21.
    Mizoshita T, Inada K, Tsukamoto T, Kodera Y, Yamamura Y, Hirai T, Kato T, Joh T, Itoh M, Tatematsu M (2001) Expression of Cdx1 and Cdx2 mRNAs and relevance of this expression to differentiation in human gastrointestinal mucosa-with special emphasis on participation in intestinal metaplasia of the human stomach. Gastric Cancer 4:185–191Google Scholar
  22. 22.
    Murray FE, Lombard M, Dervan P, Fitzgerald RJ, Crowe J (1988) Bleeding from multifocal heterotopic gastric mucosa in the colon controlled by an H2 antagonist. Gut 29:848–851Google Scholar
  23. 23.
    Seitz G, Schuder G (1987) Heterotopic gastric mucosa of the rectum. Pathologe 8:52–55Google Scholar
  24. 24.
    Stolte M, Sticht T, Eidt S, Ebert D, Finkenzeller G (1994) Frequency, location, and age and sex distribution of various types of gastric polyp. Endoscopy 26:659–665Google Scholar
  25. 25.
    Stolte M (1995) Clinical consequences of the endoscopic diagnosis of gastric polyps. Endoscopy 27:32–37Google Scholar
  26. 26.
    Vieth M, Kushima R, Borchard F, Stolte M (2003) Pyloric gland adenoma: a clinico-pathological analysis of 90 cases. Virchows Arch 442:317–321Google Scholar
  27. 27.
    Watanabe H, Jass JR, Sobin LH (eds) (1990) Histological typing of oesophageal and gastric tumours. Springer, Berlin Heidelberg New YorkGoogle Scholar
  28. 28.
    Wolff M (1971) Heterotopic gastric epithelium in the rectum: a report of three new cases with a review of 87 cases of gastric heterotopia in the alimentary canal. Am J Clin Pathol 55:604–616Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • M. Vieth
    • 1
  • R. Kushima
    • 2
  • J. P. A. de Jonge
    • 3
  • F. Borchard
    • 4
  • F. Oellig
    • 1
  • M. Stolte
    • 1
  1. 1.Institute of PathologyKlinikum BayreuthBayreuthGermany
  2. 2.Department of Clinical Science and Laboratory Medicine, Division of Diagnostic PathologyShiga University of Medical ScienceOhtsuJapan
  3. 3.Institute of Pathology, NordhornNordhornGermany
  4. 4.Institute of PathologyKlinikum AschaffenburgAschaffenburgGermany

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