Stomach
Polyps
Oxyntic gland adenoma
Authors: Natalia Liu, M.D., Hanlin L. Wang, M.D., Ph.D.
Deputy Editor-in-Chief: Raul S. Gonzalez, M.D.
Last author update: 14 July 2020
Last staff update: 4 March 2022
Copyright: 2020-2024, PathologyOutlines.com, Inc.
PubMed Search: Oxyntic gland (adenoma OR polyp)
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Cytology description | Positive stains | Negative stains | Molecular / cytogenetics description | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1 | Board review style answer #2 | Board review style answer #2Cite this page: Liu N, Wang HL. Oxyntic gland adenoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stomachoxynticglandadenoma.html. Accessed December 22nd, 2024.
Definition / general
- Benign gastric neoplasm composed of gland forming epithelial cells with predominantly chief cell differentiation resembling oxyntic glands
- Risk of progression to gastric adenocarcinoma of fundic gland type with submucosal invasion
Essential features
- Occurring in areas with oxyntic mucosa, mainly in upper third of stomach (World J Gastroenterol 2016;22:10523)
- Composed of irregular glands lined by columnar cells with a predominant chief cell component, mimicking oxyntic glands
- No recurrence following complete endoscopic excision (Am J Surg Pathol 2012;36:1030)
- If submucosal invasion is present, should be classified as gastric adenocarcinoma of fundic gland type (World J Gastroenterol 2016;22:10523)
Terminology
- Many terms have been proposed for this polyp and its related invasive lesion, including:
- Oxyntic gland polyp / adenoma
- Oxyntic gland neoplasm
- Gastric dysplasia of chief cell predominant type
- Chief cell predominant gastric polyp
- Chief cell hyperplasia with structural and nuclear atypia
- Chief cell proliferation of the gastric mucosa
- Chief cell adenoma
- Gastric neoplasia of fundic gland (chief cell predominant) type
- Gastric adenocarcinoma of fundic gland type
- Gastric adenocarcinoma of fundic gland mucosa type
- Gastric adenocarcinoma with chief cell differentiation
- Chief cell predominant adenocarcinoma
ICD coding
- ICD-O: 8210/2 - adenomatous polyp, high grade dysplasia
- ICD-O: 8210/0 - adenomatous polyp, low grade dysplasia
- ICD-11: 2E92.1 & XH3DV3 - benign neoplasm of stomach and adenoma, NOS
Epidemiology
- Age range: 39 - 87 years (most common: 60 - 70 years) (Am J Surg Pathol 2012;36:1030 )
- M = F (World J Gastroenterol 2016;22:10523)
- Most reported from Japan; only a few reports from North America and Europe (Am J Surg Pathol 2012;36:1030 )
Sites
- Stomach, usually upper third (80%)
Etiology
- Unknown
- Not associated with Helicobacter pylori infection, atrophic gastritis or intestinal metaplasia
- Questionable association with acid reduction therapy in patients with gastrointestinal reflux disease (World J Gastroenterol 2016;22:10523)
Clinical features
- Usually incidental endoscopic finding
Diagnosis
- Endoscopy
Prognostic factors
- No recurrence following endoscopic excision in all reported cases
- Risk of progression to submucosal invasion (gastric adenocarcinoma of fundic gland type) (World J Gastroenterol 2016;22:10523)
- No risk of nodal or distant metastasis
Case reports
- 49 year old man who was incidentally found to have a polypoid whitish elevation with a smooth surface in the gastric fundus measuring 1.1 cm (Case Rep Pathol 2016;2016:8646927)
- 73 year old man with 6 mm slightly elevated, yellowish lesion with irregular surface vessels detected at the greater curvature of the upper body. (World J Gastroenterol 2015;21:5099)
Treatment
- Complete excision
Clinical images
Contributed by Natalia Liu, M.D. and Hanlin L. Wang, M.D., Ph.D.
Flat raised nodule
Gross description
- Size range: 2 - 20 mm; typically < 10 mm
- Polypoid or raised flat nodules (World J Gastroenterol 2016;22:10523)
Microscopic (histologic) description
- Usually arising within the lower zone of oxyntic mucosa
- Clusters of irregular glands typically separated by radiating wisps of smooth muscle (Mod Pathol 2020;33:206)
- Dilated, branched, fused and anastomosed glands can be seen
- Composed predominantly of columnar epithelial cells with chief cell differentiation characterized by basophilic cytoplasm and relatively uniform round nuclei (World J Gastroenterol 2016;22:10523)
- Can have minor components of parietal cells and mucus cells
- No more than mild nuclear atypia (World J Gastroenterol 2016;22:10523)
- No mitosis, necrosis, desmoplasia or lymphovascular invasion
- Mucosal surface may be spared and covered by gastric foveola and nonneoplastic oxyntic glands
- If submucosal invasion is present, should be classified as gastric adenocarcinoma of fundic gland type
Microscopic (histologic) images
Contributed by Natalia Liu, M.D. and Hanlin L. Wang, M.D., Ph.D.
Low power architecture
Irregular glands
Predominantly chief cell differentiation
Contributed by @liverwei on Twitter
Oxyntic gland polyp
Oxyntic gland polyp
Cytology description
- Bland cytologic features, uniform round nuclei, inconspicuous nucleoli, abundant basophilic cytoplasm (Mod Pathol 2020;33:206)
Positive stains
- Pepsinogen I (Pathol Int 2007;57:517, Pathol Int 2013;63:318, Am J Surg Pathol 2010;34:609)
- Pepsinogen II (Pathol Int 2007;57:517)
- MUC6 (Pathol Int 2007;57:517, Pathol Int 2013;63:318, Am J Surg Pathol 2010;34:609, Am J Surg Pathol 2012;36:1030)
- Runt related transcription factor 3 (RUNX3) (Pathol Int 2007;57:517)
- CD56
- Synaptophysin (despite lacking neuroendocrine features)
- Ki67 (usually < 3%) (Histopathology 2016;68:825)
Negative stains
- MUC2 (Am J Surg Pathol 2010;34:609, Am J Surg Pathol 2012;36:1030)
- MUC5AC (Am J Surg Pathol 2010;34:609, Am J Surg Pathol 2012;36:1030)
- Chromogranin (Am J Surg Pathol 2010;34:609)
- CDX2 (Pathol Int 2007;57:517, Histopathology 2016;68:825)
- CD10 (Am J Surg Pathol 2010;34:609)
- H+ / K+ ATPase (positive in parietal cells) (Pathol Int 2013;63:318, Am J Surg Pathol 2010;34:609)
Molecular / cytogenetics description
- Missense or nonsense mutations in Wnt / beta catenin signaling pathway (APC, CTNNB1, AXIN1, AXIN2) in ~50% of cases (Hum Pathol 2013;44:2438)
- GNAS mutations in 19% of cases, almost mutually exclusive with mutations in Wnt / beta catenin pathway (Hum Pathol 2014;45:2488)
Sample pathology report
- Stomach, polyp, biopsy:
- Oxyntic gland adenoma (see comment)
- Comment: The biopsy shows bland appearing glandular proliferation in the lower portion of the oxyntic mucosa. The epithelial cells lining the glandular structures exhibit features of chief cell differentiation. No features of invasive carcinoma are identified but there is insufficient submucosal tissue present for evaluation. The findings are consistent with a diagnosis of oxyntic gland adenoma, which is regarded as a benign lesion. Complete excision of the lesion is considered curative as no recurrence or metastasis has been documented in reported cases in the literature. Given its potential risk of progression to gastric adenocarcinoma of fundic gland type, endoscopic follow up is recommended.
Differential diagnosis
- Well differentiated adenocarcinoma:
- More prominent glandular anastomosis with lateral extension
- More prominent nuclear atypia
- Increased mitotic activity
- Desmoplasia
- Presence of intestinal metaplasia
- Presence of dystrophic goblet cells
- Well differentiated neuroendocrine tumor:
- Nested or organoid growth pattern
- Salt and pepper nuclear features
- Positive immunostains for both chromogranin and synaptophysin
- Pyloric gland adenoma:
- Fundic gland polyp:
- Cystically dilated oxyntic glands lined by hypertrophic or flattened parietal cells admixed with chief cells and mucus cells
Additional references
Board review style question #1
Which of the following is true about this gastric polyp?
- GNAS mutations occur in majority of this type of polyp
- It carries a risk of progression to submucosal invasion
- It is predominantly composed of columnar epithelial cells with parietal cell differentiation
- It is usually seen in the gastric antrum
- It stains positive for both MUC5AC and chromogranin
Board review style answer #1
B. It carries a risk of progression to submucosal invasion
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Reference: Oxyntic gland adenoma
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Reference: Oxyntic gland adenoma
Board review style answer #2
What histologic feature is typically seen in an oxyntic gland adenoma?
- It frequently shows cystically dilated glands lined by hypertrophic parietal cells
- It frequently shows H. pylori gastritis in background gastric mucosa
- It frequently shows irregular glands separated by smooth muscle bundles
- It frequently shows lymphovascular invasion
- It frequently shows mitotic figures
Board review style answer #2
C. It frequently shows irregular glands separated by smooth muscle bundles
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Reference: Oxyntic gland adenoma
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