Path. Res. Pract.

188, 157-161 (1992)

Five Types of Pyloric Cells in the Antral Mucosa of the

Stomach 1,2

C. A. Rubio
Department of Pathology, Karolinska Institute, Stockholm, Sweden

SUMMARY
Only one type of pyloric cells in the exocrine antral glands is usually described in the
literature. The review of 1 00 gastrectomy specimens revealed 5 types of pyloric cells: one
composed of "ordinary" pyloric cells (i.e. cuboidal cells with ill-defined borders, pale,
bubbly cytoplasm with an unconspicous cytoplasmic network).
The second type was characterized by pyloric cells with a smalI, regular vacuole, usually
in a subnuclear position. The vacuole in such cells was negative for mucous stains. The
third type of pyloric cells had a large intracytoplasmatic vacuole. Cells with this
characteristic were found in cystically dilated pyloric glands. The vacuoles in such cells
were usually negative for mucous stains although a rim of PAS or alcian blue positive
substance was found in some vacuoles. The fourth type of pyloric cells had eosinophilic
granules in the cytoplasm. These granules were proven to contain lysozyme. The fifth type
had a non-vacuolated, homogenous ("glassy") cytoplasm which was weakly positive for
PAS but negative for acid mucines or mannosides. While the significance of the various
types of pyloric cells herein described remains unclear, their easy identification in H & E
stained preparations would permit more elaborated studies with histochemistry, immu-
nohistochemistry and/or transmission electron microscopy in the future.

Introduction complex and a granular endoplasmic reticulum. The cells

According to many authors 2,3,5-7,12, the pyloric glands
of the antral mucosa of the stomach are tubular, conspic-
uously coiled, occasionally branched glands, lined by
exocrine mucous secreting cells. These cells are cuboidal or
low columnar in shape with a pale, fine bubbly, granular
cytoplasm (due to small mucigen granules). The nucleus is
oval and situated basally. At the electron microscopical
level 12 the pyloric gland cells demonstrate heterogeneous
supranuclear mucous granules as weil as homogenous
granules resembling the zymogen granules of the chief
cells. Pyloric cells have an elaborated supranuclear Golgi
are attached to the neighbouring cells by lateral desmo-
somes and have apical junctional complexes while their
luminal aspect is furnished with sm all microvilli.
From the descriptions in the literature, it would appear
that the antral glands of the human stomach are lined by
only one type of pyloric cells. While reviewing surgical
specimens at high power examination (oil immersion) we
found pyloric cells which differed from the descriptions
given in the literature. The aim of the present work is to
give an account for the various types of pyloric cells
recorded.

1 This study was supported by grants from the Swedish Cancer
Society, the Cancer Society in Stockholm and the Karolinska
Institute.
2 Dedicated to Dr. Teruyuki Hirota on the occasion ofhis 60th
birthday.
Material and Methods
The observations made in this report are the results of the study
of a hundred consecutive gastrectomy specimens in Swedish
subjects. The patients were opera ted on between 1976 and 1989

© 1992 by Gustav Fischer Verlag, Stuttgart 0344-0338/92/0188-0157$3.50/0

158 . C. A. Rubio
for various reasons: 73 because of an adenocarcinoma (8 of them
with a so-called early gastric cancer), 26 for a benign gastric peptic
ulcer and the remaining one because of a heavy family history of
gastric malignancy (having a newly detected adenoma with high
grade dysplasia).
B~fore 1983, the tissue sampling for histological examination
of resected stomaehs comprised: 1) the lesion, 2) the lesser
curvature including the resection lines and 3) the greater curva-
ture which also included the resections lines. From 1983, the total
specimen was processed as reported elsewhere IO • In short, after
removal, the specimen was fixed in 10% neutral formalin for
three days. After fixation it was placed on a specially deviced
translucent grid, photocopied for registration and subsequently
cut with a knife following the grid lines JO • The sections were
stained with H & E PAS, alcian blue pH 2.5, High Iron Diamine
(AID), Concanavalin A, polyclonal lysozymes, orcein and
Grimelius stains.
Results
Types of PyLoric CeLLs
Five different types of pyloric cells in the antral mucosa
were observed: 1) "ordinary" pyloric cells, 2) pyloric cells
Fig. 1. "Ordinary" pyloric cells with basally located nuclei and
bubbly cytoplasm with" a tenuous basophilic network (H & E
400 x ).
wirh a small cytoplasmic va cu oie, 3) pyloric cells with a
large cytoplasmic vacuole, 4) pyloric cells with eosino-
philic cytoplasmic granules and 5) pyloric cells with
non-vacuolated, homogenous ("glassy") cytoplasm.
"Ordinary" pyLoric ceLls. These pyloric cells are the ones
described in the literature2, 3,5- 7, 12 as cuboidal cells with
ill-defined borders, pale, bubbly cytoplasm, with an
unconspicuous basophilic network. The nucleus adopts a
basal position (Fig. 1). The cytoplasm is strangly positive
for PAS in about 80% of the cells and for Concanavalin A
in about 90% of the cells. The other cells remain unstained
for those two reactions.
PyLoric ceLls with a smaLl cytoplasmic vacuole. This type
is characterized by pyloric cells having a small regular
cytoplasmic vacuole, usually seen in the subnuclear aspect
of the cytoplasm. In some cells the vacuole may occupy a
supranuclear or nucleo-Iateral position. These cells are
usually seen in one single gland or in groups of pyloric
glands (Fig. 2). The vacuoles contain fat B . They remain
negative for mucines or mannosides.
Fig. 2. Cluster of pyloric glands with small vacuoles in the
subnuclear portion of the cytoplasm (H & E, 400x).

Pylorie cells with a large eytoplasmie vaeuole. This type
of pyloric cells is characterized by a large cytoplasmic
vacuole usually covering cystically dilated glands (Fig. 3)
in areas with intestinal metaplasia on top. Histochemical
reactions may show a faintly positive PAS substance
attached to part of the wall of the vacuole. The same has
been observed in a few cells when using alcian blue pH 2.5.
The majority of the vacuoles remain, however, unstained
for mucines or mannosides.
Pylorie cells with eosinophilie granules. Pyloric glands
may be partially or entirely replaced by pyloric cells
containing fine eosinophilic cytoplasmic gramIles of simi-
lar size (Fig. 4). These granules thus differ from the coarse
granulation found in Paneth cells. The density of the
eosinophilic granules found in pyloric cells may vary. The
adjacent pyloric glands re ta in the characteristics of "ordi-
nary" pyloric cells. The granules are positive only for
lysozymes.
Pylorie cells with non-vaeuolated, homogenous ("glas-
sy") eytoplasm. This type of pyloric cells is characterized
Fig.3. Pyloric glands having cells with large cytoplasmic
vacuoles. Note the occurrence of intestinal metaplastic cells with
vacuolated cytoplasm (upper left corner) (H & E, 400x).
Pyloric Cells, Gastric Mucosa . 159
by a homogenous, "opaque" cytoplasm with a laterally
located, relatively large nucleus (Fig. 5). PAS staining was
faintly (+) positive while it was negative for acid mucines,
mannosides, Grimelius stain and orcein. The adjacent
pyloric cells retain the characteristics of "ordinary" pyloric
cells.
The results in Table 1 show that "ordinary" pyloric cells
were present in all 100 specimens. In addition, 12 of the
100 specimens contained pyloric cells with a small cyto-
plasmic vacuole, 11 pyloric cells with a large cytoplasmic
vacuole, 5 pyloric cells with eosinophilic cytoplasmic
granules and one pyloric cells with non-vacuolated, homo-
genous ("glassy") cytoplasm. Pyloric cells with "glassy"
cytoplasm were observed in a gastrectomy specimen
having a gastric peptic ulcer. The remaining four types of
pyloric cells were unrelated to the presence of a gastric
carcinoma or a peptic gastric ulcer.
The various types of pyloric cells (excluding "ordinary"
pyloric cells) were unrelated to the neighbourhood of a
carcinoma, a peptic ulcer or the adenoma.
Discussion
The results presented above indicate that several types of
pyloric cells may be present in the antral mucosa from
patients with various gastric diseases. These results are at
variance with the previous descriptions in the litera-
ture2, 3, 5-7, 12 in which only one type of pyloric cells was
described.
The absence of staining with Concanavalin A (which
only binds to mannosides I4 ), and with PAS in a few percent
of cells, suggests that "ordinary" pyloric cells may differ
functionally.
The significance of the pyloric cells with a small
cytoplasmic vacuole remains obscure. Since our original
description 8, 9 these cells have been investigated at various
centreslI, 13. TEM have demonstrated that the vacuoles
contain fat 13 .
Pyloric cells with a large vacuole appear to depend upon
the development of retained secretion in cystically dilated
pyloric glands 8 . Whether the pressure of mucous retained
in the lumen of the cysts impedes the extrusion of cellular
mucous (which is being accumulated) is unclear. The
presence of a rim of PAS or alcian blue-positive substance
~gainst apart of the wall of the vacuole remains enigmat-
le.
The eosinophilic granules seen in H & E stained prepa-
rations were demonstrated immunohistochemically to
contain lysozyme. The distribution of lysozymes in man
has been thoroughly investigated4; they have been found in
many glands of the gastrointestinal tract, including pyloric
glands 4 . Lysozymes are known to form complexes, with a
variety of acid mucopolysaccharides 4 . The reasons for the
occurrence of pyloric cells with eosinophilic granules in
5% in our material remains unexplained.
Pyloric cells with non-vacuolated, homogenous "glas-
sy" cytoplasm were found in only 1 % of the specimens.
The material contained in the cytoplasm reacted weakly
(+ ) with PAS. This contrasted with the strong PAS reaction
160 . C. A. Rubio

Table 1. Thc various types of pyloric cells found in 100 resected stomaehs

Cytoplasmic changes
"ordinary" sm all vacuoles large vacuoles eosinophilic gran- "glassy" cyroplasm
ules

Adenoma 73 9 7 3
Gastric ulcer 26 3 3 2
Adenoma 1 1
All 100 12 11 5

(+ + +) seen in the foveolar cells in the same sections. This
observation lead us to believe that the substallCe in those
cells may not be a neutral mucin. The negative reaction for
alcian blue, HID and Concanavalin A suggests that the
substance is not sialomucin, a sulphomucin or a manno-
side. In H & E stained preparations, the cytoplasm re sem-
bles the "glassy" appearance of hepatocytes infected by
hepatitis virus 1 • "Glassy" hepatocytes react with orcein
stain 1• The same stain was, however, negative in "glassy"
pyloric cells. Staining for mannosides or neuroendocrine
granules were also negative. At this point it should be
mentioned that while reviewing gastrectomy specimens in
spanish patients, we recently found a case having "glassy"
pyloric cells in a patient operated upon for Menetrier
disease (C Rubio's and F Rivera's personal observa-
tion).
It is at present unknown whether the various types of
pyloric cells reported above represent functional stages
connected with the elaboration of to-be-secreted products
in the same cell or different types of pyloric cells having
disparate physiological functions. The preserved struc-

Fig.4. Left: Pyloric cells with eosinophilic cytoplasmic granules, more prominent in some groups of cells (H & E, 1000X). - Right:
Immunohistochemical stain for lysozyme. Note positive rcaction (IMH lysozyme (400x) (filter: 510 nm).

Fig. 5. Pyloric cells with "glassy" cytoplasm (H & E, 400 x).
tures of the ce11s militate against different steps of ce11ular
necrobiosis.
There was no indication that neighbourhood to a
neoplastic or to an ulcerogenic lesion could give rise to the
cytoplasmic changes herein reported. In fact, except for
"ordinary" ce11s, a11 other types of pyloric ce11s were found
far from the lesions that determined the gastric resec-
tion.
While the significance of the various types of pyloric
ce11s described above remains at present obscure, their easy
identification in H & E or other stains would permit a
Received December 14, 1990 . Accepted in revised form April 22, 1991
Key words: Pylorie cells - Gastrie mucosa - Vaeuoles - Eosinophilie granules
C. A. Rubio, Department of Pathology, Karolinska Institute, Stockholm, Sweden
Pyloric Cells, Gastric Mucosa . 161
more elaborated study of those cells by histochemistry,
immunohistochemistry and electron microscopy in the
future.
In many countries, the stomach is the most common site
for cancer development. The ce11s from which many of
these tumors originate remain unknown. It should there-
fore be of primary concern to increase our knowledge on
the characteristics of the normal ce11s in that organ.
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