Immunohistochemical analysis of pyloric gland adenomas using a series of Mucin 2, Mucin 5AC, Mucin 6, CD10, Ki67 and p53
A pyloric gland adenoma (PGA) of the stomach was first described in a book chapter in 1976 by Kurt Elster and has been rarely reported in the literature. We expanded the current immunohistochemical data of these adenomas in a detailed series to further analyse the immunhistochemical status of PGA. From 60 patients with PGA with and without adenocarcinomas of the gastrointestinal tract, an immunhistochemical panel of Mucin 2, Mucin 5AC, Mucin 6, CD10, Ki67 and p53 was used to define the expression of these markers. All PGA were positive for Mucin 6 (deep mucoid glands), which they express over the whole lesion up to the surface. Mucin 5AC expression varies from case to case. A transition from gastric to intestinal differentiation can be observed focally as depicted by Mucin 2 and CD10 in 65% of the cases. The gastric corpus mucosa of elderly patients with either Helicobacter pylori gastritis or autoimmune gastritis is highly affected. Almost 47% of all PGA already underwent malignant transformation into adenocarcinoma. Significant immunohistochemical differences could be detected between PGA with and without adenocarcinoma regarding ki67 and p53. The diagnosis of PGA can be confirmed immunohistochemically by staining against apomucin 6 and apomucin 5AC. Focal intestinal differentiation supports the hypothesis that gastric adenocarcinomas can initially develop from carcinomas of the gastric type and transform into intestinal type later on. The high frequency of malignant transformation of PGA underlines its high potential for invasive malignancy.
KeywordsPyloric gland adenoma Immunohistochemistry Adenocarcinoma Gastro-intestinal tract
This manuscript is dedicated to Professor Manfred Stolte on occasion of his 70th birthday. The authors declare no conflict of interest.
- 3.Kushima R, Müller W, Stolte M, Borchard F (1996) Differential p53 protein expression in gastric adenomas of gastric and intestinal types: possible sequence of p53 alteration in the stomach carcinogenesis according to histological and mucin histochemical phenotypes. Virchows Arch 428:223–227PubMedGoogle Scholar
- 4.Hamilton SR, Aaltonen LA (eds) (2000) WHO classification of tumours. Tumours of the digestive system. IARC, LyonGoogle Scholar
- 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 74:528Google Scholar
- 7.Watanabe H, Gass JF, Sobin LH (1990) Histological typing of oesophageal and gastric tumours. Spinger, BerlinGoogle Scholar
- 8.Elster K (1976) Histologic classification of gastric polyps. In: Morson BC (ed) Pathology of the gastro-intestinal tract. Springer, Berlin, pp 78–92Google Scholar
- 9.Borchard F (1987) 16. Tutorial IAP, Tumoren des oberen Gastrointestinaltraktes, DüsseldorfGoogle Scholar
- 12.Itoi T, Watanabe H, Ajioka Y, Ooohashi Y, Takei K, Nishikura K, Nakamura Y, Horic A, Saito T (1996) APC, K-ras codon 12 mutations and p53 gene expression in carcinoma and adenoma of the gall-bladder suggest two genetic pathways in gall-bladder carcinogenesis. Pathol Int 46:333–340CrossRefPubMedGoogle Scholar
- 15.Michal M, Crurik R, Matler K, Benes Z (2003) Regarding the paper by Vieth et al. Virchows Archiv 443/4:317-321. Virchows Archiv 443:589–590Google Scholar
- 19.Kushima R, Mukaisho K, Vieth M, Borchard F, Stolte M, Hattori T (2003) Pyloric-gland-type adenomas of the stomach. Stomach and Intestine (Tokyo) 38:1377–1387Google Scholar
- 20.Kushima R (2004) Pyloric gland adenoma. Pathology and Clinical Medicine 22:634–635Google Scholar