Pyloric Gastric Adenoma With Low Grade Dysplasia in an Asymptomatic 50-Year-Old Asian Female With Negative H. Pylori

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Keywords

adult, Asian, atrophic gastritis, case report, clinical article, comorbidity, conference abstract, depression, diagnosis, dysplasia, electronic medical record, endoscopic mucosal resection, endoscopic submucosal dissection, endoscopic surgery, endoscopic therapy, esophagogastroduodenoscopy, female, follow up, Helicobacter pylori, human, human tissue, intraepithelial neoplasia, iron deficiency anemia, meta analysis, middle aged, prevalence, pylorus, pylorus gland, scar tissue, stomach adenoma, stomach cancer, stomach lesion, stomach polyp, surgery, treatment guideline

Abstract

Introduction: Pyloric gastric adenoma (PGA), a rare precancerous lesion, is prevalent in populations with a high incidence of gastric cancer. A meta-analysis indicates that tumors larger than 2 cm with a depressed or nodular surface may lead to increased dysplasia after endoscopic resection. This case details the incidental discovery of a 3 cm granular flat lesion in the cardia during esophagogastroduodenoscopy (EGD) in an asymptomatic 50-year-old Asian woman. The aim is to shed light on the management of pyloric gastric adenoma in the Western context, where its low prevalence makes it less recognized. Case Description/Methods: A 50-year-old East-Asian woman with a history of iron deficiency anemia underwent EGD, unveiling a 3 cm granular lesion (Paris 0-IIa, NICE type 2, pit pattern III) at the cardia/ fundus junction. Biopsies confirmed pyloric adenoma with low-grade dysplasia. No other gastric lesions seen. Decision was made to proceed to endoscopic submucosal dissection (ESD). A resected 8 x 4 cm specimen showed no reverse target sign. Pathology revealed pyloric adenoma with low-grade dysplasia, and margins were negative. Discussion: The 2019 WHO classification categorizes gastric adenomas into intestinal or gastric origin, with pyloric gland adenoma in Japan and highly differentiated adenocarcinoma for foveolar-type intraepithelial neoplasia/adenoma. More common in Asia, these lesions are less frequent in the West. PGA is more common in females (3:1), possibly associated with autoimmune gastritis. Approximately 2% of gastric polyps are PGAs, typically in geriatric females with autoimmune gastritis or chronic mucosal damage, with an average age at diagnosis of about 60 years old. High-grade PGAs often exhibit tubulovillous architecture. Overall, PGAs progress to adenocarcinoma in 12%-47% of cases within 10-48 months (60%-85% for HGD and 23% for LGD). Hence, it is imperative to remove them early.No clear therapeutic guidelines exist for gastric low-grade dysplasia (LGD) management, necessitating case-by-case decisions. Given the patient's age and lack of comorbidities, a joint decision favored endoscopic resection, with ESD chosen over endoscopic mucosal resection (EMR) for its en-bloc capability. The patient underwent close follow-up with an EGD in 3 months. The scar from previous ESD was biopsied, and it was negative for recurrence. This case highlights a rare gastric lesion in Western countries and adequate endoscopic treatment of the same with ESD. (Figure Presented).

Volume

119

Issue

10

First Page

S2642

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