Endoscopic features of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type): a case report

Abstract

A 64-year-old Helicobacter pylori infection-naïve woman was found to have a small (≤ 10 mm) depression on the anterior wall of the upper gastric body. On white light endoscopy, the lesion appeared to be inconspicuous, whitish with dilated vessels. 0.2% indigo carmine chromoendoscopy enable better visualization of the depression. On narrow band imaging with magnification, the microsurface structure of the surrounding mucosa was absent and a network of tortuous microvessels were observed within the depressed area. Endoscopic ultrasonography indicated that the tumor was confined to the mucosa. The lesion was removed by endoscopic submucosal dissection. Histological finding of the resected specimen revealed that carcinomatous tubules existed in the deep part of the lamina propria with minimal (300 μm) submucosal invasion which were covered with the atrophic non-neoplastic foveolar epithelium. The tumor was diffusely positive for MUC6 and pepsinogen-I, while it was negative for MUC5AC and H+/K+-ATPase. A diagnosis of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type) was made.

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type): A review of endoscopic and clinicopathological features

“…A review of studies on GA-FG-CCP published in English language indicates that 46 cases have been reported to date[4-16]. Almost all patients were Japanese, but a study by Singhi et al[9] in 2012 comprised 10 non-Asian patients, including Hispanics, Caucasians and African-Americans.…”

“…With respect to coloration, GA-FG-CCP is often covered with normal-colored or faded ( i.e ., whitish or yellowish) mucosa. Fujii et al[16] suggested that the faded appearance is caused by atrophy in the foveolar epithelium above cancer tubules, but not in the surrounding mucosa. Another characteristic of GA-FG-CCP is vasodilation on the tumor surface, which is attributed to the displacement of surface vessels by tumor tissue followed by congestion[13].…”

“…Branched vessels on the tumor surface were also thought to be present in the deep region of the mucosal layer[12]. Narrow-band imaging (NBI) may clarify the presence of vasodilatation and branched vessels on the tumor surface[12,13,16]. However, it has not been possible to pathologically confirm the above explanations for fine vessels.…”

“…There are few reports on magnifying endoscopy for GA-FG-CCP[13,16]. NBI with magnification is assessed using the worldwide standard diagnostic system, the VS (vessel plus surface) classification, as proposed by Yao et al[18].…”

“…In contrast, NBI with magnification indicated that some GA-FG-CCPs had normal MSP and MVP. The presence of the DL, and irregular MVP and MSP, which are specific features of early gastric adenocarcinoma, may not be found in GA-FG-CCP[16]. Because GA-FG-CCP is located in the deep mucosal layer and is not exposed on the surface, detection of abnormal inner microstructures is prevented by the thick mucosa[13].…”