Your pathology report for intestinal type adenoma of the stomach

by Jason Wasserman MD PhD FRCPC
July 27, 2025

An intestinal type adenoma is a non-cancerous growth that starts from the inner lining of the stomach. It is called an “adenoma” because it is made up of abnormal gland-forming cells. These adenomas are considered precancerous, which means they have the potential to turn into cancer over time. Intestinal type adenoma is the third most common type of stomach polyp, after hyperplastic polyps and fundic gland polyps.

Where in the stomach are intestinal type adenomas found?

Most intestinal type adenomas are found in the antrum, the lower portion of the stomach near where it connects to the small intestine (duodenum).

Why is it called an intestinal type adenoma?

This type of adenoma is called “intestinal type” because the abnormal cells in the polyp look very similar to the cells normally found in the small intestine. These changes occur as part of a condition called intestinal metaplasia, where the normal stomach lining is replaced by cells that resemble intestinal tissue.

What are the symptoms of an intestinal type adenoma?

Most people with intestinal type adenomas do not have any symptoms. These polyps are usually found during an endoscopy performed for another reason, such as evaluation of symptoms like heartburn or indigestion. Sometimes, symptoms are related to underlying conditions, such as Helicobacter pylori (H. pylori) infection, rather than the adenoma itself.

What causes an intestinal type adenoma?

Intestinal type adenomas develop in areas of the stomach that have undergone intestinal metaplasia, a condition where the normal stomach lining is replaced by intestinal-type cells. Causes of intestinal metaplasia and subsequent adenoma formation include:

How is this diagnosis made?

An intestinal type adenoma of the stomach is diagnosed after a doctor performs a procedure called an upper endoscopy (gastroscopy). During this procedure, a thin, flexible tube with a camera is inserted through the mouth to examine the inside of the stomach. If a polyp or abnormal area is seen, the doctor may remove it entirely or take small tissue samples, called biopsies, for further examination.

The removed tissue is then sent to a pathologist, a doctor who specializes in diagnosing disease by examining tissue under a microscope.

What does an intestinal type adenoma look like under the microscope?

When examined under the microscope, an intestinal type adenoma is made up of abnormal glandular cells that form elongated structures called tubules. These cells often have dark, elongated nuclei that may overlap. Another key feature is the presence of goblet cells, which are large round cells filled with mucin (a substance that becomes mucus). Goblet cells are normally found in the small intestine and help confirm that the adenoma is of the intestinal type.

Pathologists may also describe the growth as a polyp, which is a mass that protrudes from the surface of the stomach lining.

What does dysplasia mean and why is it important?

All intestinal type adenomas show a precancerous change called dysplasia. Dysplasia means that the cells are growing in an abnormal way, although they are not yet cancerous. Pathologists divide dysplasia into two categories based on how abnormal the cells look under the microscope.

Intestinal type adenoma with low grade dysplasia

Most intestinal type adenomas show low grade dysplasia, meaning the cells are mildly to moderately abnormal. Low grade dysplasia has a low risk of becoming cancer, especially if the adenoma is small and completely removed. However, if left untreated, low grade dysplasia can progress to high grade dysplasia or cancer over time.

Intestinal type adenoma with high grade dysplasia

High grade dysplasia means the cells look very abnormal and are closer to turning into cancer. While not cancer yet, adenomas with high grade dysplasia carry a much higher risk of becoming a type of stomach cancer called adenocarcinoma. For this reason, high grade dysplasia should be completely removed if possible.

What is a margin and why is it important?

A margin refers to the edge of tissue that is cut during the removal of the adenoma. After the procedure, a pathologist examines the tissue to see whether any abnormal cells are present at the cut edge:

  • Negative margin: No dysplasia or adenoma cells are seen at the edge. This suggests the adenoma was completely removed.

  • Positive margin: Dysplastic or adenomatous cells are found at the edge. This raises the possibility that some of the adenoma was left behind, and further treatment may be needed.

Some adenomas are removed in one piece (often with a stalk), while others are removed in multiple fragments. If the adenoma is removed in pieces, it may be difficult for the pathologist to determine the margin status, and the report may not comment on margins.

Can an intestinal type adenoma turn into cancer?

Yes. Although intestinal type adenomas are benign, they are considered precancerous because they can develop into adenocarcinoma, a common type of stomach cancer, especially if left untreated.

The risk is higher in adenomas that:

For this reason, complete removal and follow-up endoscopy are often recommended, especially if high grade dysplasia is found.

Questions to ask your doctor

  • Was the entire adenoma removed?

  • Did the pathology report show low grade or high grade dysplasia?

  • Were the margins clear of abnormal cells?

  • Will I need another endoscopy or biopsy to monitor for recurrence?

  • Should I be tested for Helicobacter pylori or other underlying conditions?

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