Subscribe to RSS
DOI: 10.1055/a-0862-0098
Pyloric gland adenoma in the duodenal bulb: case report of a giant laterally spreading tumor treated with endoscopic submucosal dissection
Publication History
Publication Date:
13 March 2019 (online)
![](https://www.thieme-connect.de/media/endoscopy/201906/lookinside/thumbnails/0932_10-1055-a-0862-0098-1.jpg)
A 55-year-old man underwent gastroduodenoscopy because of epigastric pain. Abdominal computed tomography revealed a uniformly enhanced mass (10 × 8 mm) within the duodenum, with no enlargement of lymph nodes ([Fig. 1]). A laterally spreading tumor, with a diameter of about 60 mm, was detected within the duodenal bulb ([Fig. 2]). The lesion involved the pylorus ring and had a positive lifting sign. Considering the difficulty of endoscopic resection of such a giant lesion in the duodenal bulb, surgical resection was proposed, but the patient refused. Therefore, a standard endoscopic submucosal dissection was performed ([Video 1]).
![](https://www.thieme-connect.de/media/endoscopy/201906/thumbnails/10-1055-a-0862-0098-i0932ev1.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/201906/thumbnails/10-1055-a-0862-0098-i0932ev2.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Video 1 Endoscopic submucosal dissection of a large laterally spreading pyloric gland adenoma in the duodenal bulb.
Quality:
Grossly, the resected tissue measured 60 × 50 mm ([Fig. 3]). The pathological examination revealed pyloric gland adenoma accompanied by some regional high grade intraepithelial neoplasia ([Fig. 4]). The lateral and vertical margins of the specimen were negative. No complications occurred during the procedure.
![](https://www.thieme-connect.de/media/endoscopy/201906/thumbnails/10-1055-a-0862-0098-i0932ev3.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
![](https://www.thieme-connect.de/media/endoscopy/201906/thumbnails/10-1055-a-0862-0098-i0932ev4.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
A repeat gastroduodenoscopy about 1 year later showed no significant abnormalities in the duodenal bulb ([Fig. 5]).
![](https://www.thieme-connect.de/media/endoscopy/201906/thumbnails/10-1055-a-0862-0098-i0932ev5.jpg)
![Zoom Image](/products/assets/desktop/css/img/icon-figure-zoom.png)
Pyloric gland adenoma (PGA) is a rare neoplasm, composed of tightly packed tubules (occasionally cystic dilation) with pyloric gland differentiation, which mainly occurs in the stomach [1]. Since the first description of PGA by Elster in 1976, few PGAs have been documented to originate from the duodenum [2] [3] and other extragastric sites; in addition, most reported PGAs have been < 25 mm [4]. Nowadays, PGA is a recognized precancerous disease, with a reported rate of association with adenocarcinoma ranging from 12 % to 47 % [5]. The risk of developing adenocarcinoma is associated with its size and the presence of high grade dysplasia [4]. Therefore, endoscopic removal of PGA is indicated. In our report, a rare giant duodenal PGA was described and successfully treated with endoscopic submucosal dissection.
Endoscopy_UCTN_Code_CCL_1AB_2AZ_3AB
Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
* These authors contributed equally to this work.
-
References
- 1 Pezhouh MK, Park JY. Gastric pyloric gland adenoma. Arch Pathol Lab Med 2015; 139: 823-826
- 2 Kushima R, Rüthlein HJ, Stolte M. et al. “Pyloric gland-type adenoma” arising in heterotopic gastric mucosa of the duodenum, with dysplastic progression of the gastric type. Virchows Arch 1999; 435: 452-457
- 3 Poeschl EM, Siebert F, Vieth M. et al. Pyloric gland adenoma arising in gastric heterotopia within the duodenal bulb. Endoscopy 2011; 43 (Suppl. 02) E336-337
- 4 Vieth M, Kushima R, Borchard F. et al. Pyloric gland adenoma: a clinico-pathological analysis of 90 cases. Virchows Arch 2003; 442: 317-321
- 5 Vieth M, Kushima R, Mukaisho K. et al. Immunohistochemical analysis of pyloric gland adenomas using a series of Mucin 2, Mucin 5AC, Mucin 6, CD10, Ki67 and p53. Virchows Arch 2010; 457: 529-536