P2838 - Pyloric Gastric Adenoma With Low Grade Dysplasia in an Asymptomatic 50-Year-Old Asian Female With Negative H. Pylori

Ahmed E. Salem, MBBCh¹, Syed Mujtaba Baqir, MD¹, Morad Zaaya, MD¹, Syed Matthew. Kodilinye, MD¹, Hazem Abosheaishaa, MD², Carla Barberan Parraga, MD³, Khaled Elfert, MD⁴, Islam Mohamed, MD⁵, Mohammed Abusuliman, MD⁶, Sarah Meribout, MD¹, Mohamed Elnaggar, MD⁷, Muhammad Ali Chaudhry, MBBS¹, Pranay Siriya, MD¹, Bani Chander Roland, MD⁸, Daniel A. DiLeo, MD⁸, Manol Jovani, MD^1
1Maimonides Medical Center, Brooklyn, NY; ²Icahn School of Medicine at Mount Sinai, Queens, NY; ³Maimonides Medical Center, New York, NY; ⁴West Virginia University, Morgantown, WV; ⁵University of Missouri - Kansas City School of Medicine, Kansas City, MO; ⁶Henry Ford Health, Detroit, MI; ⁷Hartford HealthCare, Hartford, CT; ⁸VA New York Harbor Health System, Brooklyn, NY

Introduction: Pyloric gastric adenoma (PGA), a rare precancerous lesion, is prevalent in populations with a high incidence of gastric cancer. A meta-analysis indicates that tumors larger than 2 cm with a depressed or nodular surface may lead to increased dysplasia after endoscopic resection. This case details the incidental discovery of a 3 cm granular flat lesion in the cardia during esophagogastroduodenoscopy (EGD) in an asymptomatic 50-year-old Asian female. The aim is to shed light on the management of pyloric gastric adenoma in the Western context, where its low prevalence makes it less recognized.

Case Description/Methods: A 50-year-old East-Asian female with a history of iron deficiency anemia underwent EGD, unveiling a 3 cm granular lesion (Paris 0-IIa, NICE type 2, pit pattern III) at the cardia/fundus junction. Biopsies confirmed pyloric adenoma with low-grade dysplasia. No other gastric lesions seen. Decision was made to proceed to endoscopic submucosal dissection (ESD). A resected 8x4 cm specimen showed no reverse target sign. Pathology revealed pyloric adenoma with low-grade dysplasia, and margins were negative.

Discussion: The 2019 WHO classification categorizes gastric adenomas into intestinal or gastric origin, with pyloric gland adenoma in Japan and highly differentiated adenocarcinoma for foveolar-type intraepithelial neoplasia/adenoma. More common in Asia, these lesions are less frequent in the West. PGA is more common in females (3:1), possibly associated with autoimmune gastritis. Approximately 2% of gastric polyps are PGAs, typically in geriatric females with autoimmune gastritis or chronic mucosal damage, with an average age at diagnosis of about 60 years old. High-grade PGAs often exhibit tubulovillous architecture. Overall, PGAs progress to adenocarcinoma in 12%-47% of cases within 10-48 months (60%-85% for HGD and 23% for LGD). Hence, it is imperative to remove them early.



No clear therapeutic guidelines exist for gastric low-grade dysplasia (LGD) management, necessitating case-by-case decisions. Given the patient's age and lack of comorbidities, a joint decision favored endoscopic resection, with ESD chosen over endoscopic mucosal resection (EMR) for its en-bloc capability. The patient underwent close follow-up with an EGD in 3 months. The scar from previous ESD was biopsied, and it was negative for recurrence. This case highlights a rare gastric lesion in Western countries and adequate endoscopic treatment of the same with ESD.



Disclosures:


Ahmed E. Salem, MBBCh¹, Syed Mujtaba Baqir, MD¹, Morad Zaaya, MD¹, Syed Matthew. Kodilinye, MD¹, Hazem Abosheaishaa, MD², Carla Barberan Parraga, MD³, Khaled Elfert, MD⁴, Islam Mohamed, MD⁵, Mohammed Abusuliman, MD⁶, Sarah Meribout, MD¹, Mohamed Elnaggar, MD⁷, Muhammad Ali Chaudhry, MBBS¹, Pranay Siriya, MD¹, Bani Chander Roland, MD⁸, Daniel A. DiLeo, MD⁸, Manol Jovani, MD¹. P2838 - Pyloric Gastric Adenoma With Low Grade Dysplasia in an Asymptomatic 50-Year-Old Asian Female With Negative <i>H. Pylori</i>, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.