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


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.


Pyloric-gland adenoma Rectum polyp Heterotopic gastric mucosa 


  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

Personalised recommendations