Skip to main content

Advertisement

SpringerLink
Log in

Large duodenal pyloric gland adenoma successfully resected by endoscopic submucosal dissection

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

A 71-year-old woman was given a barium meal examination as part of a workup for recurring melena and iron deficiency anemia (IDA), and it revealed a large duodenal polyp measuring 60 mm in diameter. Subsequent upper gastrointestinal endoscopy showed a large pedunculated polyp in the duodenal bulb. Magnifying endoscopy with narrow-band imaging (NBI) showed that the lesion consisted of a regular enlarged intervening part between crypts of the epithelium that resembled gastric mucosa. Although the lesion was suspected of being benign, it was resected by endoscopic submucosal dissection (ESD) to prevent the progression of the IDA. The pathology examination revealed the proliferation of mildly irregular-shaped or dilated glands lined by cuboidal cells and low columnar cells in the submucosa. The gastric glands were immunohistochemically positive for MUC6, suggesting pyloric gland differentiation. The lesion was covered by a foveolar-type epithelium, and we made a diagnosis of pyloric gland adenoma (PGA). PGAs are most common in the stomach, and they are rare in the duodenum, where endoscopic treatment is technically challenging. Here we report a case of large duodenal PGA successfully resected by ESD. Since part of PGAs has been reported to be associated with adenocarcinoma, minimally invasive treatment strategies are desirable to reduce the risk of progression to carcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Pezhouh MK, Park JY. Gastric pyloric gland adenoma. Arch Pathol Lab Med. 2015;139:823–6.

    Article  CAS  Google Scholar 

  2. Bakotic BW, Robinson MJ, Sturm PD, et al. Pyloric gland adenoma of the main pancreatic duct. Am J Surg Pathol. 1999;23(2):227–31.

    Article  CAS  Google Scholar 

  3. Yahagi N, Kato M, Ochiai Y, et al. Outcomes of endoscopic resection for superficial duodenal epithelial neoplasia. Gastrointest Endosc. 2018;88(4):676–82.

    Article  Google Scholar 

  4. Chen ZM, Scudiere JR, Abraham SC, et al. Pyloric gland adenoma: An entity distinct from gastric foveolar type adenoma. Am J Surg Pathol. 2009;33(2):186–93.

    Article  Google Scholar 

  5. Endo M, Abiko Y, Oana S, et al. Usefulness of endoscopic treatment for duodenal adenoma. Dig Endosc. 2010;22:360–5.

    Article  Google Scholar 

  6. Tsuji S, Doyama H, Tsuji K, et al. Preoperative endoscopic diagnosis of superficial non-ampullary duodenal epithelial tumors, including magnifying endoscopy. World J Gastroenterol. 2015;21:11832–41.

    Article  Google Scholar 

  7. Maruoka D, Arai M, Ishigami H, et al. Cold polypectomy for nonampullary duodenal adenoma. Endoscopy. 2015;47(Suppl 1):E477–8.

    PubMed  Google Scholar 

  8. Mitsuishi T, Hamatani S, Hirooka S, et al. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS ONE. 2017;12(4):e0174985.

    Article  Google Scholar 

  9. Kushima R, Mukaisho K, Vieth M, et al. Pyloric-gland-type adenomas of the stomach. Stomach Intestine. 2003;38:1377–87.

    Google Scholar 

  10. Kushima R. “Jūnishichō: Igata no sennshu gan” [Gastric-type Adenoma and Adenocarcinoma of the Duodenum]. Stomach and Intestine. 2020;55:425–8 ((in Japanese)).

    Google Scholar 

  11. Miller GC, Kumarasinghe MP, Borowsky J, et al. Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases. Histopathology. 2020;76:404–10.

    Article  Google Scholar 

  12. Kushima R, Rüthlein HJ, Stolte M, et al. “Pyloric gland-type adenoma” arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type. Virchows Arch. 1999;435:452–7.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Endoscopy, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan

    Shunya Takayanagi, Eiji Sakai, Takashi Muramoto & Ken Ohata

  2. Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan

    Hirotsugu Hashimoto

Authors
  1. Shunya Takayanagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eiji Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takashi Muramoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hirotsugu Hashimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ken Ohata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ken Ohata.

Ethics declarations

Conflict of interest

Ken Ohata, Shunya Takayanagi, Eiji Sakai, Takashi Muramoto, and Hirotsugu Hashimoto declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takayanagi, S., Sakai, E., Muramoto, T. et al. Large duodenal pyloric gland adenoma successfully resected by endoscopic submucosal dissection. Clin J Gastroenterol 14, 538–541 (2021). https://doi.org/10.1007/s12328-021-01367-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-021-01367-w

Keywords

Search

Navigation