A case of gastric adenocarcinoma with pyloric gland-type infiltrating submucosa

Kaiho Hirata; Shusuke Yagi; Hideki Miyazaki; Kazuhiko Yamada; Naoki Akazawa; Naoki Enomoto; Kyoko Nohara; Chizu Yokoi; Toru Igari; Norihiro Kokudo

doi:10.1186/s40792-024-01835-8

A case of gastric adenocarcinoma with pyloric gland-type infiltrating submucosa

Surg Case Rep. 2024 Apr 7;10(1):78. doi: 10.1186/s40792-024-01835-8.

Authors

Affiliations

¹ Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan.
² Department of Pathology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan.
³ Department of Surgery, Center Hospital of the National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan. kayamada@hosp.ncgm.go.jp.
⁴ Department of Gastroenterology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan.

Abstract

Background: The development of immunohistochemical staining has revealed that gastric adenocarcinoma with the gastric phenotype can be divided into the foveolar, fundic gland, and pyloric gland phenotypes. Gastric adenocarcinoma of the pyloric gland type is difficult to diagnose using biopsy because of its low atypia and rarity. Herein, we describe a case of gastric adenocarcinoma of the pyloric gland type that was diagnosed immunohistochemically after endoscopic resection.

Case presentation: A 67-year-old man was referred to our hospital for the diagnosis and treatment of a 30-mm elevated lesion on the lesser curvature side of the middle of the gastric body. Although four biopsies were performed, it was difficult to determine whether the lesion was benign or malignant. Therefore, endoscopic submucosal dissection was performed, and the presence of tumor cells infiltrating the submucosa with venous invasions was identified. Immunohistochemical staining revealed that the tumor cells were positive for MUC5AC and MUC6 and negative for Pepsinogen I and H + /K + -ATPase. From the above findings, he was diagnosed as having gastric adenocarcinoma with pyloric gland type. The patient underwent a laparoscopic distal gastrectomy and was discharged without any adverse events.

Conclusions: Gastric adenocarcinoma of the pyloric gland type is a rare disease, and endoscopic resection can serve as a viable diagnostic option for this condition when it is difficult to diagnose using biopsy. Immunohistochemical pathology images can aid in the diagnosis of gastric adenocarcinoma of the pyloric gland type.

Keywords: Gastric adenocarcinoma with pyloric gland type; Gastric cancer; Immunohistochemical staining.