What are the other Names for this Condition? (Also known as/Synonyms)

• Gastric PGA
• Pyloric Gland Adenoma of Stomach
• Pyloric Gland Intracystic Papillary Neoplasm

What is Gastric Pyloric Gland Adenoma? (Definition/Background Information)

• Gastric Pyloric Gland Adenoma is a polyp that occurs in the pyloric region of the stomach. These polyps usually arise in the fundus area of the stomach, or in the gastric body
• Sometimes, high-grade dysplasia can be noted in these pyloric gland adenomas (PGAs)
• Most of the polyps are asymptomatic and detected incidentally on an endoscopy

Incidence:

• Usually occur in adults between the 6th and 7th decade (ages 50 to 70 years)
• Both males and females are affected, but the tumor is more common in females than males

Risk factors:

• Helicobacter pylori infection
• Autoimmune gastritis: Sporadic Gastric Pyloric Gland Adenomas are associated with the atrophic autoimmune gastritis
• Gastric Pyloric Gland Adenoma can be associated with certain syndromes such as:
  • Familial adenomatous polyposis (FAP) syndrome
  • Gastric adenocarcinoma and proximal polyposis of stomach (GAPPS)
  • McCune-Albright syndrome
  • Juvenile polyposis syndrome
  • Lynch syndrome

Cause:

• The exact cause of formation of Gastric Pyloric Gland Adenoma is currently unknown
• Both sporadic tumors and those associated with familial adenomatous polyposis syndrome typically present GNAS and/or KRAS mutations and inactivating APC mutations

The following genetic alterations are observed:

• Gastric and duodenal PGAs often present GNAS and KRAS gene mutations
• In sporadic and syndromic PGA, mutations on GNAS, KRAS, and APC genes are noted
• Pyloric gland adenoma with or without cytological dysplasia may present KRAS, APC, TP53, and CTNNB1 gene mutations

Signs and symptoms:

• A majority of these polyps are asymptomatic, causing no signs and symptoms
• Usually, the tumors are 2 cm in (average) size. The size can range from 0.3 cm to up to 10 cm 

Diagnosis:

• The polyps may be diagnosed incidentally when an endoscopy is performed for other health conditions
• Tissue biopsy is necessary for a definitive diagnosis
• Differential diagnosis on pathological examination include:
  • Gastric foveolar-type adenoma
  • Hyperplastic polyp
  • Oxyntic gland adenoma of stomach
  • Reactive foveolar hyperplasia

Such tumors can also occur in other sites of the gastrointestinal tract such as:

• Bile duct
• Cervix (very rarely)
• Duodenal bulb (of the duodenum)
• Esophagus
• Gallbladder
• Pancreas
• Pancreatic duct
• Rectum

Complications:

• It is estimated that 40% of these tumors are associated with high-grade dysplasia
• Complications may arise from the associated genetic syndrome

Treatment:

• If there are areas of cancer within the polyp, then a complete resection is recommended
• Endoscopic mucosal resection with clear surgical margins often results in cure
• Close clinical follow-up with frequent endoscopic examination may be necessary

Prevention: Presently, it is not possible to prevent the formation of Gastric Pyloric Gland Adenomas.

Prognosis: The prognosis is typically excellent; a complete removal of the tumor can result in a cure.