Year 2021 / Volume 113 / Number 9
Letter
Dead-end stomach: a giant and pedunculated gastric pyloric gland adenoma conditioning gastric outlet obstruction and anemia

678-679

DOI: 10.17235/reed.2021.7820/2021

Raquel Pimentel, Elisa Gravito-Soares, Marta Gravito-Soares, Pedro Figueiredo,

Abstract
We present the case of a 69-year-old female undergoing esophagogastroduodenoscopy for iron-deficiency anemia investigation. She reported intermittent bloating, nausea and vomiting. A pedunculated polyp was identified arising from the greater curvature of the middle gastric body, with a long fibroelastic stalk (30mm) and a 60mm congestive head that prolapsed towards the pyloric ring, causing a complete gastric outlet obstruction (GOO). An en-block polypectomy was performed. An intraprocedural oozing bleeding from a large visible vessel at the residual stalk was managed using endoloop®. Histo-immunohistochemistry showed a R0-resection of a mixed-type gastric pyloric gland adenoma (PGA) positive for MUC-5AC and MUC-6 mucins, in a surrounding H. pylori-negative non-atrophic chronic gastritis. She became asymptomatic with anemia resolution. Adenomas account for up to 10% of gastric polyps. Histologically, they are categorized into intestinal, foveolar, pyloric and oxyntic types (1). PGA is a rare subtype, accounting for less than 3% of all gastric polyps (2). PGAs are usually solitary at gastric body, and occur in association with autoimmune gastritis, H. pylori and chemical gastritis (2). A normal background gastric mucosa has also been described (35.8%) (3). PGAs are devoid of apical mucin cap and label by both MUC-5AC and MUC-6 (2). Choi et al. (3) defined three PGA immunohistochemical phenotypes: pure pyloric-type (25.4%), with strong MUC-6 expression; predominant foveolar-type (3%), with MUC-5AC diffuse expression but ≤10% of MUC-6 expression and no foveolar differentiation; and mixed-type (61.2%), with variable MUC-5AC/MUC-6 expression. Most PGAs are asymptomatic, but clinically significant because of their potential for malignant transformation (12-47%) and complications, including gastrointestinal bleeding and obstruction (1, 3). GOO is rare, causing intermittent symptoms by polyp intussusception (ball-valve-syndrome) (4, 5). PGA management is challenging, depending on size, morphology and location. This case illustrates a successful endoscopic resection as a minimally invasive procedure of a doubly complicated PGA.
Share Button
New comment
Comments

17/05/2023 11:55:38
And is very painful


17/05/2023 11:55:15
I have gastria


References
1. Robinson JC, Hoffman B, Sun S. Gastric adenomas: subtypes and their clinical significance. Pathol Case Rev 2013;18:70-4.
2. Pezhouh MK, Park JY. Gastric pyloric gland adenoma. Arch Pathol Lab Med 2015;139:823-6.
3. Choi WT, Brown I, Ushiku T, et al. Gastric pyloric gland adenoma: a multicentre clinicopathological study of 67 cases. Histopathology 2018;72:1007-14.
4. Kosai NR, Gendeh HS, Norfaezan AR, et al. Prolapsing gastric polyp causing intermittent gastric outlet obstruction. Int Surg 2015;100:1148-52.
5. Parikh M, Kelley B, Rendon G, et al. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010;2:242-6.
Related articles

Digestive Diseases Image

Enteroenteric intussusception caused by a small bowel metastatic cutaneous melanoma

DOI: 10.17235/reed.2023.9876/2023

Letter

Anemia can predict organ failure in acute pancreatitis

DOI: 10.17235/reed.2023.9700/2023

Letter

Duodenal pyogenic granuloma: An unusual cause of chronic anemia

DOI: 10.17235/reed.2022.9411/2022

Letter

Giant ascending colonic lipoma accompanied by intussusception

DOI: 10.17235/reed.2022.9041/2022

Digestive Diseases Image

Splenosis as an incidental finding in a patient with multifactorial anemia

DOI: 10.17235/reed.2022.8733/2022

Letter

Gastrointestinal lymphoma, a rare endoscopic lesion

DOI: 10.17235/reed.2022.8555/2021

Letter

Small-bowel hemangioma as a cause of chronic anemia

DOI: 10.17235/reed.2020.6969/2020

Case Report

Primary colon mantle lymphoma: a misleading macroscopic appearance!

DOI: 10.17235/reed.2019.6405/2019

Letter

Ischemic gastritis due to oral iron

DOI: 10.17235/reed.2019.6401/2019

Letter

Gastric serrated adenoma

DOI: 10.17235/reed.2019.6145/2018

Digestive Diseases Image

Contribution of the virtual colonoscopy in a case of intestinal intussusception

DOI: 10.17235/reed.2017.5261/2017

Letter to the Editor

Ileocecal endometriosis as an infrequent cause of intussusception

DOI: 10.17235/reed.2017.5183/2017

Case Report

Cannabis intake and intussusception: an accidental association?

DOI: 10.17235/reed.2016.4288/2016

Citation tools
Pimentel R, Gravito-Soares E, Gravito-Soares M, Figueiredo P. Dead-end stomach: a giant and pedunculated gastric pyloric gland adenoma conditioning gastric outlet obstruction and anemia. 7820/2021


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 2148 visits.
This article has been downloaded 129 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 22/01/2021

Accepted: 27/01/2021

Online First: 11/02/2021

Published: 07/09/2021

Article Online First time: 20 days

Article editing time: 228 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology