Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

TY - JOUR

T1 - Clinicopathological features of pyloric gland adenomas of the duodenum: a multicentre study of 57 cases

AU - Miller, Gregory C

AU - Kumarasinghe, M Priyanthi

AU - Borowsky, Jennifer

AU - Choi, Won-Tak

AU - Setia, Namrata

AU - Clauditz, Till

AU - Gidwani, Raja

AU - Sufiyan, Wajiha

AU - Lauwers, Gregory Y

AU - Brown, Ian S

N1 - © 2019 John Wiley & Sons Ltd.

PY - 2020/2

Y1 - 2020/2

N2 - AIMS: To determine the clinicopathological features of pyloric gland adenomas (PGA) that arise in the duodenum.METHODS AND RESULTS: Fifty-seven cases of duodenal PGA were identified and analysed from 56 patients. Clinicopathological and immunohistochemical analyses were performed. PGA tend to occur in older individuals (median age = 73.5), with a slight female predominance (25 males, 31 females). PGA arise more commonly in the proximal duodenum (68.75% in D1, 25% in D2 and 6.25% in D3) and usually present as mucosal nodules (98.2%) or plaques (1.8%), with a mean size of 14.8 mm. There is associated gastric heterotopia in 22.8% of cases. PGA showing features of high-grade dysplasia were significantly larger in size than PGA, showing only low-grade dysplasia (23.1 versus 8.7 mm; P = 0.0001) and more likely to show a tubulovillous rather than a pure tubular architecture (P = 0.025). In our series, 10 of 56 patients had intramucosal or invasive carcinoma associated with the duodenal PGA (17.9%). Three of these carcinomas showed lymph node metastasis. Following definitive treatment, local recurrence occurred in only three patients.CONCLUSIONS: Duodenal PGA tend to occur in the proximal duodenum of older individuals. Larger size and tubulovillous architecture correlates with high-grade dysplasia and associated adenocarcinoma. The low recurrence rate of these lesions would suggest that endoscopic management is appropriate, provided that the lesion can be completely resected.

AB - AIMS: To determine the clinicopathological features of pyloric gland adenomas (PGA) that arise in the duodenum.METHODS AND RESULTS: Fifty-seven cases of duodenal PGA were identified and analysed from 56 patients. Clinicopathological and immunohistochemical analyses were performed. PGA tend to occur in older individuals (median age = 73.5), with a slight female predominance (25 males, 31 females). PGA arise more commonly in the proximal duodenum (68.75% in D1, 25% in D2 and 6.25% in D3) and usually present as mucosal nodules (98.2%) or plaques (1.8%), with a mean size of 14.8 mm. There is associated gastric heterotopia in 22.8% of cases. PGA showing features of high-grade dysplasia were significantly larger in size than PGA, showing only low-grade dysplasia (23.1 versus 8.7 mm; P = 0.0001) and more likely to show a tubulovillous rather than a pure tubular architecture (P = 0.025). In our series, 10 of 56 patients had intramucosal or invasive carcinoma associated with the duodenal PGA (17.9%). Three of these carcinomas showed lymph node metastasis. Following definitive treatment, local recurrence occurred in only three patients.CONCLUSIONS: Duodenal PGA tend to occur in the proximal duodenum of older individuals. Larger size and tubulovillous architecture correlates with high-grade dysplasia and associated adenocarcinoma. The low recurrence rate of these lesions would suggest that endoscopic management is appropriate, provided that the lesion can be completely resected.

U2 - 10.1111/his.13996

DO - 10.1111/his.13996

M3 - SCORING: Journal article

C2 - 31529725

VL - 76

SP - 404

EP - 410

JO - HISTOPATHOLOGY

JF - HISTOPATHOLOGY

SN - 0309-0167

IS - 3

ER -