Ahmed E. Salem, MBBCh1, Syed Mujtaba Baqir, MD1, Morad Zaaya, MD1, Syed Matthew. Kodilinye, MD1, Hazem Abosheaishaa, MD2, Carla Barberan Parraga, MD3, Khaled Elfert, MD4, Islam Mohamed, MD5, Mohammed Abusuliman, MD6, Sarah Meribout, MD1, Mohamed Elnaggar, MD7, Muhammad Ali Chaudhry, MBBS1, Pranay Siriya, MD1, Bani Chander Roland, MD8, Daniel A. DiLeo, MD8, Manol Jovani, MD1 1Maimonides Medical Center, Brooklyn, NY; 2Icahn School of Medicine at Mount Sinai, Queens, NY; 3Maimonides Medical Center, New York, NY; 4West Virginia University, Morgantown, WV; 5University of Missouri - Kansas City School of Medicine, Kansas City, MO; 6Henry Ford Health, Detroit, MI; 7Hartford HealthCare, Hartford, CT; 8VA New York Harbor Health System, Brooklyn, NY
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 female. 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 female 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 8x4 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: A resected 8x4 cm specimen showed no reverse target sign. Pathology revealed pyloric adenoma with low-grade dysplasia
Disclosures:
Ahmed Salem indicated no relevant financial relationships.
Syed Mujtaba Baqir indicated no relevant financial relationships.
Morad Zaaya indicated no relevant financial relationships.
Syed Kodilinye indicated no relevant financial relationships.
Hazem Abosheaishaa indicated no relevant financial relationships.
Carla Barberan Parraga indicated no relevant financial relationships.
Khaled Elfert indicated no relevant financial relationships.
Islam Mohamed indicated no relevant financial relationships.
Mohammed Abusuliman indicated no relevant financial relationships.
Sarah Meribout indicated no relevant financial relationships.
Mohamed Elnaggar indicated no relevant financial relationships.
Muhammad Ali Chaudhry indicated no relevant financial relationships.
Pranay Siriya indicated no relevant financial relationships.
Bani Chander Roland indicated no relevant financial relationships.
Daniel DiLeo indicated no relevant financial relationships.
Manol Jovani indicated no relevant financial relationships.
Ahmed E. Salem, MBBCh1, Syed Mujtaba Baqir, MD1, Morad Zaaya, MD1, Syed Matthew. Kodilinye, MD1, Hazem Abosheaishaa, MD2, Carla Barberan Parraga, MD3, Khaled Elfert, MD4, Islam Mohamed, MD5, Mohammed Abusuliman, MD6, Sarah Meribout, MD1, Mohamed Elnaggar, MD7, Muhammad Ali Chaudhry, MBBS1, Pranay Siriya, MD1, Bani Chander Roland, MD8, Daniel A. DiLeo, MD8, Manol Jovani, MD1. P2838 - Pyloric Gastric Adenoma With Low Grade Dysplasia in an Asymptomatic 50-Year-Old Asian Female With Negative <i>H. Pylori</i>, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.