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

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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