Surgical Pathology Criteria

Adenomatous Polyps of the Stomach

Differential Diagnosis

Summary of differences between gastric adenoma types
Adenoma Type Nuclei Cytoplasm Mucin Assoc Carcinoma/HGD
Intestinal Elongated, hyperchromatic Focal GC and PC Goblets positive,MUC2+5-6- Gastritis and IM High
Foveolar Elongated, hyperchromatic Apical mucin cap PAS+, AB+, MUC2-5+6- FAP None
Pyloric Round, may be bland or atypical Ground glass PAS-AB- MUC2-5+ 6+ Gastritis and IM, FAP, Lynch High
Oxyntic Round, bland Varies with cell type MUC2-5-6+ None None
Assoc = associations, HGD = high grade dysplasia, GC = goblet cells, PC = Paneth cells MUC5 = MUC5AC, IM = intestinal metaplasia, PAS = periodic acid Schiff stain with diastase (neutral mucin), AB = Alcian Blue stain (acid mucin), FAP = familial adenomatous polyposis

 

Gastric Adenoma with High Grade Dysplasia vs. Adenocarcinoma

 

Gastric Hyperplastic Polyp Gastric Adenomatous Polyp, Pyloric Type
Edematous, inflamed stroma Stroma not prominent
Irregular, branched pits Clusters of small regular glands with interspersed cystic glands
Cysts lined by mucin positive foveolar epithelium Cysts lined by mucin negative pyloric gland epithelium

 

Gastric Hyperplastic Polyp with Regenerative Epithelial Atypia Gastric Adenomatous Polyp, Intestinal and Foveolar Types
Atypia associated with erosion and acute inflammation Adenomatous features (intestinal type only) should be independent of inflammation
Edematous, inflamed stroma Stroma not prominent
Cystic dilation usually present Cystic dilation is unusual in adenomas
Frequently has regular, single, prominent nucleoli in regenerative areas Irregular chromatin pattern in most cases

 

Brunner Gland Adenoma or Nodule Gastric Adenomatous Polyp, Pyloric Type
MUC5AC negative MUC5AC positive

 

Esophageal Submucosal Gland Duct Adenoma Esophageal or Gastric Adenomatous Polyp, Intestinal Type
Cytologically bland Cytologically dysplastic
Two cell layers One cell layer
Outer layer has myoepithelial phenotype No myoepithelial component

 

Esophageal Submucosal Gland Duct Adenoma Gastric Adenomatous Polyp, Pyloric Type
Mixed tubular and papillary pattern Tubular, no papillary component
Two cell layers One cell layer
Outer layer has myoepithelial phenotype No myoepithelial component
Inner layer has intensely eosinophilic cytoplasm Pale eosinophilic cytoplasm

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