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Kitagawa D, Yamasaki T, Ikeda T, Sakata Y, Hirata N, Suekane T, Sugimori S, Ishii N, Sakurai K, Nebiki H. A case of pyloric gland adenoma with high-grade dysplasia in the duodenum arising from heterotopic gastric mucosa observed over 5 years. Clin J Gastroenterol 2023; 16:26-31. [PMID: 36306058 DOI: 10.1007/s12328-022-01721-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
Pyloric gland adenoma (PGA) in the duodenum is a rare gastric phenotype duodenal neoplasm. Although heterotopic gastric mucosa in the duodenum has been recognized as a benign lesion, it is a potential precursor of PGA and gastric phenotype adenocarcinoma. Herein, we present a case follow-up of endoscopic and histological changes in the PGA in the duodenum from low-grade to high-grade dysplasia. PGA was considered to arise from the heterotopic gastric mucosa, because the heterotopic gastric mucosa was observed in the initial examination. It is difficult to distinguish heterotopic gastric mucosa from PGAs, both endoscopically and histologically. This increase in size may be useful for their differentiation. Therefore, endoscopists should not underestimate the growth of the heterotopic gastric mucosa compared to that in the previous examination.
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Affiliation(s)
- Daiki Kitagawa
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Tomoaki Yamasaki
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan.
| | - Tetsuya Ikeda
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Yuhei Sakata
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Naoto Hirata
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Takehisa Suekane
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Satoshi Sugimori
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Naomi Ishii
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Katsunobu Sakurai
- Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Nebiki
- Department of Gastroenterology, Osaka City General Hospital, 2-13-22, Miyakojima Hon-dori, Miyakojima-ku, Osaka, 534-0021, Japan
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Duodenal neoplasms of gastric phenotype: reports of two cases and a brief review of literature. Eur J Cancer Prev 2021; 29:210-214. [PMID: 32168033 DOI: 10.1097/cej.0000000000000530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Duodenal neoplasms of gastric phenotype are uncommon epithelial neoplasms. Pyloric gland adenomas should be recognized as neoplasms with risk for transformation into invasive adenocarcinoma (). Here we report the case histories of two male patients, who presented with duodenal polypoid lesion. Endoscopic polypectomy and endoscopic submucosal dissection were carried out, respectively. Histopathologically, both polyps showed features of neoplasms of gastric phenotype. The clinical and endoscopic features, pathologic features, immunophenotype, molecular pathogenesis, clinical management and prognosis of the two cases will be discussed. We will also briefly review the latest literatures on duodenal neoplasms of gastric phenotype.
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Mitsuishi T, Hamatani S, Hirooka S, Fukasawa N, Aizawa D, Hara Y, Dobashi A, Goda K, Fukuda T, Saruta M, Urashima M, Ikegami M. Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors). PLoS One 2017; 12:e0174985. [PMID: 28376132 PMCID: PMC5380350 DOI: 10.1371/journal.pone.0174985] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/18/2017] [Indexed: 12/16/2022] Open
Abstract
Objective Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors. Materials and methods Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands. Results As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands. Conclusions About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands.
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Affiliation(s)
- Takehiro Mitsuishi
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- * E-mail:
| | - Shigeharu Hamatani
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Shinichi Hirooka
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Daisuke Aizawa
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuko Hara
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takahiro Fukuda
- Division of Neuropathology, Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masahiro Ikegami
- Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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