Gastric Pyloric Gland Adenoma: A Case Report, Review of Literature, and Diagnostic Challenges in the Philippine Setting

Pyloric gland adenoma (PGA) is a rare neoplasm with definite malignant potential that is difficult to recognize because of its characteristically bland histology. We present a case of a 74-year old female with chronic, intermittent symptoms referable to gastroesophageal reflux, bloatedness, and frequent flatus, with family history of gastric cancer. Initial endoscopy was done and biopsy revealed an inflammatory pseudopolyp. After six months, repeat endoscopy showed multiple polyps at the cardia, and biopsy of one of the visualized polyps was done. Microscopic sections of the polyp show a neoplasm composed of discrete glands lined by simple cuboidal to columnar epithelial cells with amphophilic to eosinophilic cytoplasm without apical mucin caps, and mild nuclear atypia. Mild epithelial stratification is noted in some of the glands. PAS staining showed granular, cytoplasmic staining in tumor cells. Immunohistochemical staining with P53 showed focal, weak, nuclear staining in tumor cells. Staining with Ki67, MUC2, MUC5AC, and MUC6 were not done because the tissue had already been exhausted. The diagnosis of PGA with low-grade dysplasia has been made. The patient is apparently well, and is advised surveillance endoscopy at six-month intervals. PGA may be diagnosed in a limited resource setting, through thorough histologic examination, and use of special histochemical stains.