P5112 - Pyloric Enigma: Uncommon Manifestation of Gastritis Cystica Profunda

Maliyat Matin, MD¹, Bibhuti Adhikari, MD¹, Richard Mitchell, MD¹, Bobby Thomas, MD¹, Woo Suk Kim, DO¹, Tasur Seen, MD¹, Nirali Sheth, MD², Genanew Bedanie, MD¹, Anastasia Novikov, MD², Aaron Walfish, MD¹, Joshua Aron, MD², Krishna Gurram, MD^1
1Elmhurst Hospital Center / Icahn School of Medicine at Mount Sinai, Queens, NY; ²Elmhurst Hospital Center / Icahn School of Medicine at Mount Sinai, Elmhurst, NY

Introduction: Gastritis cystica profounda (GCP) is a rare phenomenon first described by Scott and Payne in 1947. It is a benign lesion characterized by hyperplasia and cystic dilation of gastric glands in the submucosal layer. Although the etiology is not fully understood, it is suggested to be a manifestation of the hyperplastic and metaplastic responses of mucosal injury from factors such as chronic inflammation, ischemia or the presence of a foreign body (ie surgical sutures). GCP usually occurs in the fundus of the stomach, however can also present in the cardia, corpus and antrum. Here we present an unusual case of GCP found in the pylorus with extension into the duodenum.

Case Description/Methods: A 65 yo male with a pmh of seizure disorder presented with persistent nausea, vomiting and abdominal pain. CTAP demonstrated a distended stomach with a 6cm multiloculated cystic mass in the region of the gastric antrum, causing gastric outlet obstruction. He underwent an EGD, which revealed bilobed cystic nodules obstructing the pylorus and a cystic nodule in the duodenal bulb. Diagnostic/therapeutic aspiration of the cystic lesion was done, and pathology showed a rare clusters of benign appearing glandular cells of the gastric type. He underwent repeat EGD along with EUS 7 days later. EGD again showed multiple cystic masses in the pylorus and the duodenal bulb. EUS demonstrated multiple small anechoic circumferential cystic masses in the pylorus, along with one circumferential cystic mass in the pylorus measuring 19mm by 14.6mm in cross-sectional diameter, and one anechoic circumferential cystic mass in the duodenal bulb. The cystic lesion in the pylorus was again aspirated and a gastric stent was placed. Patient was started on PPI daily and his diet was slowly advanced to solids, which he tolerated well. He was then discharged from the hospital and with plans for distal gastrectomy in the near future.

Discussion: The presented case highlights an unusual manifestation of gastritis cystica profunda with involvement of the pylorus and extension into the duodenal bulb, an occurrence not previously documented in literature. GCP is a rare benign lesion of hyperplastic and cystic dilation of gastric glands in the submucosal layer most commonly seen in the fundus of the stomach. Radiographic appearance of GCP may overlap with more ominous conditions such as adenocarcinoma or GIST, and therefore it is important to include GCP in the differential when encountering cystic lesions in the pylorus or duodenal bulb.



Disclosures:


Maliyat Matin, MD¹, Bibhuti Adhikari, MD¹, Richard Mitchell, MD¹, Bobby Thomas, MD¹, Woo Suk Kim, DO¹, Tasur Seen, MD¹, Nirali Sheth, MD², Genanew Bedanie, MD¹, Anastasia Novikov, MD², Aaron Walfish, MD¹, Joshua Aron, MD², Krishna Gurram, MD¹. P5112 - Pyloric Enigma: Uncommon Manifestation of Gastritis Cystica Profunda, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.