Gastric Adenomas: Subtypes and Their Clinical Significance

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Gastric adenomas are neoplastic lesions, representing up to 10% of all gastric polyps (Endoscopy 1994; 26:659–665). Three epithelial subtypes are currently recognized, each carrying unique clinical implications. Intestinal-type gastric adenomas are the most common subtype and by definition contain foci of intestinal type epithelium with acidic intestinal mucins (Mod Pathol 2003; 16:786–795). They commonly arise in a background of atrophic gastritis with intestinal metaplasia. Foci of high-grade dysplasia and intramucosal or invasive adenocarcinoma are often present. Foveolar-type gastric adenomas are the second most common type of adenoma. Although also dysplastic, they typically have a less aggressive behavior and are rarely associated with high-grade dysplasia or adenocarcinoma. Characterized by gastric epithelium with neutral foveolar mucins, foveolar-type gastric adenomas generally arise in either a background of unremarkable mucosa or familial adenomatous polyposis syndrome (Am J Surg Pathol 2002; 26:1276–1285). Pyloric gland adenomas are the third most prevalent neoplastic gastric polyp (Virchows Arch 2003; 442:317–321). They resemble the deep mucous glands found near the pylorus with a remarkably bland appearance. However, similar to intestinal-type adenomas, pyloric gland adenomas are also typically associated with a more aggressive clinical course and arise in a background of atrophic gastritis (Virchows Arch 2010; 457:529–536). As the awareness of pyloric gland adenoma increases, the relative frequencies of these entities are subject to change.

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