A Case of Early Gastric Cancer Following Natural Disappearance of Fundic Gland Polyps

Abstract Background and study aims Magnifying endoscopy with narrow band imaging (M-NBI) has made a huge contribution to endoscopic diagnosis of early gastric cancer (EGC). However, we sometimes encountered false-negative cases with M-NBI diagnosis (i. e., M-NBI diagnostic limitation lesion: M-NBI-DLL). However, clinicopathological features of M-NBI-DLLs have not been well elucidated. We aimed to clarify the clinicopathological features and histological reasons of M-NBI-DLLs. Patients and methods In this single-center retrospective study, M-NBI-DLLs were extracted from 456 EGCs resected endoscopically at our hospital. We defined histological types of M-NBI-DLLs and analyzed clinicopathologically to clarify histological reasons of M-NBI-DLLs. Results Of 456 EGCs, 48 lesions (10.5 %) of M-NBI-DLLs were enrolled. M-NBI-DLLs was classified into four histological types as follows: gastric adenocarcinoma of fundic-gland type (GA-FG, n = 25), gastric adenocarcinoma of fundic-gland mucosal type (GA-FGM, n = 1), differentiated adenocarcinoma (n = 14), and undifferentiated adenocarcinoma (n = 8). Thirty-nine lesions of M-NBI-DLLs were H. pylori-negative gastric cancers (39/47, 82.9 %). Histological reasons for M-NBI-DLLs were as follows: 1) completely covered with non-neoplastic mucosa (25/25 GA-FG, 8/8 undifferentiated adenocarcinoma); 2) well-differentiated adenocarcinoma with low-grade atypia (1/1 GA-FGM, 14/14 differentiated adenocarcinoma); 3) similarity of surface structure (10/14 differentiated adenocarcinoma); and 4) partially covered and/or mixed with a non-neoplastic mucosa (1/1 GA-FGM, 6/14 differentiated adenocarcinoma). Conclusions Diagnostic limitations of M-NBI depend on four distinct histological characteristics. For accurate diagnosis of M-NBI-DLLs, it may be necessary to fully understand endoscopic features of these lesions using white light imaging and M-NBI based on these histological characteristics and to take a precise biopsy.

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Use of Proton Pump Inhibitors and Risks of Fundic Gland Polyps and Gastric Cancer: Systematic Review and Meta-analysis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2016.12.007 ◽

2017 ◽

Vol 15 (5) ◽

pp. 790 ◽

Cited By ~ 2

Author(s):

Robert H. Palmer

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis ◽

Fundic Gland ◽

Fundic Gland Polyps

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Use of Proton Pump Inhibitors and Risks of Fundic Gland Polyps and Gastric Cancer: Systematic Review and Meta-analysis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2016.05.018 ◽

2016 ◽

Vol 14 (12) ◽

pp. 1706-1719.e5 ◽

Cited By ~ 76

Author(s):

An Tran-Duy ◽

Bart Spaetgens ◽

Arno W. Hoes ◽

Niek J. de Wit ◽

Coen D.A. Stehouwer

Keyword(s):

Gastric Cancer ◽

Systematic Review ◽

Proton Pump Inhibitors ◽

Proton Pump ◽

Meta Analysis ◽

Fundic Gland ◽

Fundic Gland Polyps

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A Case of Very Well Differentiated Early Gastric Cancer Surrounded by the Fundic Gland Mucosa without Atrophy

Progress of Digestive Endoscopy(1972) ◽

10.11641/pdensks.51.0_182 ◽

1998 ◽

Vol 51 (0) ◽

pp. 182-183

Author(s):

Yusuke Iizuka ◽

Atsushi Mitsunaga ◽

Megumi Uchiyama ◽

Kouji Uchida ◽

Yukihito Nemoto ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Fundic Gland ◽

Well Differentiated

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Endoscopic and Pathological Characteristics of Helicobacter pylori Infection-Negative Early Gastric Cancer

Digestive Diseases ◽

10.1159/000506120 ◽

2020 ◽

Vol 38 (6) ◽

pp. 474-483 ◽

Cited By ~ 1

Author(s):

Taku Mizutani ◽

Hiroshi Araki ◽

Chiemi Saigo ◽

Jun Takada ◽

Masaya Kubota ◽

...

Keyword(s):

Gastric Cancer ◽

Helicobacter Pylori ◽

Early Gastric Cancer ◽

Chromogranin A ◽

Pyloric Gland ◽

Fundic Gland ◽

Pepsinogen I ◽

Cardiac Gland ◽

Gland Type ◽

E Cadherin

Background: The characteristics of Helicobacter pylori (HP) infection-negative gastric cancer (HPINGC) have not been well documented because of the rareness. The aim of this study was to classify HPINGC endoscopically and clinicopathologically. Methods: This retrospective study included 1,741 early gastric cancer lesions and evaluated their HP infection status. Expression levels of MUC5AC, MUC6, MUC2, CD10, p53, MIB-1, pepsinogen-I, H+/K+ ATPase, chromogranin A, E-cadherin, and gastrin were evaluated in tumors by immunohistochemistry (IHC). Results: Among the analyzed lesions, 19 (1.1%) were diagnosed as HPINGC and classified into 6 types: undifferentiated (5 lesions), fundic gland (2 lesions), cardiac gland (1 lesion), pyloric gland (3 lesions), foveolar (5 lesions), and mixed (3 lesions) types. Undifferentiated lesions were of pale color, with unclear demarcation and decreased E-cadherin expression. Fundic-type lesions were tan to reddish in color, with submucosal tumor-like protrusions, and positive for pepsinogen-I and H+/K+ ATPase. The cardiac gland type was located in the gastroesophageal junction and was positive for MUC6 and pepsinogen-I. Pyloric gland-type lesions were of the same color as normal mucosa, with mild elevation and unclear demarcation, likely positive for CD10 and chromogranin A. Foveolar epithelial-type lesions were white and elevated, with defined demarcation, and contained MUC5AC-positive cells. Mixed-type lesions, showing various staining patterns in IHC, had both elevated and depressed shape and reddish color. Conclusion: Endoscopic observation and IHC were useful for classifying the characteristics of HPINGC, which may preserve the characteristics of its region of origin.

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