Recently I have found aggregation of fundic glands in the pylorus of total gastrectomy specimen. Grossly it was a pouch-like structure consisting of normal gastric mucosa but with fundic glands not antral type mucinous glands. What pathologic diagnosis should I consider? Gastric heteropia? Fundic metaplasia? I couldn't find any appropriate name for this condition in the textbooks or articles.
I vote for metaplasia, epithelium (or epithelial metaplasia). This lesion sounds reactive to the gastrectomy (metaplasia), while the term heterotopia or ectopia brings to mind a developmental malformation, which doesn't sound like what is happening.
Never heard of fundic metaplasia in pylorus,, generally it is the other way round; i think that heterotropia would be more appropriate;;
In clinical practice, when the surface epithelium of the duodenum becomes like that of gastric foveole we refer to it as "gastric metaplasia". When instead there are type fundic glands we denote as "heterotopia of gastric mucosa of fundic type", although it is probably associated with H. pylori infection and is probably not congenital
In addition to metaplasia and heterotopia, you should also consider that this could be native fundic/oxyntic glands. Clinical correlation could be helpful. What type of gastrectomy was performed? Although it sounds easy, it may not always be straigtforward for the endoscopist to identify accuratly the anastomosis and therefore to label the biopsy location correctly. In conclusion, you should give a descriptive diagnosis here since you cannot be totally sure what the right solution is in this case.
The specimen was subtotal gastrectomy including lower part of the body and antrum and pylorus down to small part of duodenum. I'm aware of the meaning and findings of "gastric metaplasia of foveolar type" or "fundic type" in duodenum and "gastric heterotopia" of duodenum. But, how about fundic glands in pyloric ring? when I examine the specimen grossly, the lesion surely was on pylorus (stomach) not duodenum. Is this lesion just alright for the patient? is it a normal condition? or any other specific terminology to designate the lesion?
And one more thing to say, the lesion was not only microscopically found but also noticeable on gross examination. At first look, I was wondering if it was ectopic pancreas because small pouch-like structure looked just benign. But when I get the slides, it was just small group of fundic gladns opposed to my first thought.
Here is a gross photo of the specimen. it looks like a protruded mass, but the overlying mucosa was unremarkable, and it was a pouch-like structure lined by gastric mucosa of fundic glands. small depressed lesion with irregular margin was noted more proximally, which was confirmed as adenocarcinoma by microscopic examination later.
Oh gentlemen, is this some kind of contest so that you can make a diagnosis just by gross appearance? Give me a break and show me pathology pictures.
The reason why I didn't upload microscopic pictures here was first, surprisingly there's nothing special than I just described above like only fundic glands with normal foveolar epithelium and second, I am temporarily too busy to take pictures. I'll take pictures and upload them some time today.
Dear Yosep,
not knowing whether you know this article or if this could be of help anyway:
Gastric adenocarcinoma of the fundic gland type shares common genetic and phenotypic features with pyloric gland adenoma
Ryoji Kushima, Shigeki Sekine, Akiko Matsubara, Hirokazu Taniguchi, Masahiro Ikegami, Hitoshi Tsuda
Pathology International, Volume 63, Issue 6, pages 318–325, June 2013
http://onlinelibrary.wiley.com/doi/10.1111/pin.12070/abstract
Best regards and wishes.
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