Sporadic foveolar-type adenoma in gastric body/antrum junction with gastritis cystica profunda

Abstract

Background Sporadic gastric foveolar-type adenomas are extremely rare and are usually small, flat or slightly raised lesions that occur in the oxyntic mucosa. Case presentation We reported here a case of a 70-year-old female with a sporadic gastric foveolar-type adenoma occurring in the mucosa at the junction of the gastric body/antrum. The adenoma was a protruding lesion of 2 × 1.8 cm sized, causing symptoms of upper gastrointestinal bleeding, and the basal and surrounding mucosa showed pseudopyloric gland metaplasia without atrophy, intestinal metaplasia, H. pylori infection, or active inflammation. It had somatic mutations in both APC and KRAS genes. Conclusions This is the first reported case of a large sporadic gastric foveolar-type adenoma that occurred in the mucosa of pseudopyloric gland metaplasia and with Gastritis Cystica Profunda, which modify our understanding of the morphological features and molecular underpinnings of this type of lesion.

An Unusual Cause of GI Blood Loss

“…Very few cases of GFAs have been reported in the literature. 5,6,10,11 Classically, these lesions are associated with hereditary tumor syndromes such as familial adenomatous polyposis and gastric adenocarcinoma and proximal gastric polyposis. 11 In addition, these lesions are typically described as small, flat, or depressed and arise in areas of unremarkable gastric mucosa, rarely resulting in clinically relevant symptoms.…”

“…All lesions were in the upper or middle stomach. 6 A second study by Jian Guan et al 5 describes the “first case” of a large (2.3 cm), protruding GFA in the junction of the gastric body/antrum leading to clinically relevant symptoms of gastrointestinal bleeding. The lesion they identified was described as a broad-based polyp with a papillary or gyrus-like appearance on the surface.…”

“…The lesion they identified was described as a broad-based polyp with a papillary or gyrus-like appearance on the surface. 5 From the images included in their study, the lesion appeared pedunculated. Our case describes the first instance of a sporadic moderate-sized sessile gastric foveolar adenoma with a strawberry-like appearance developing in the gastric cardia, causing the clinically relevant symptoms of gastrointestinal bleed.…”

“…4 Gastric foveolar-type adenomas (GFA), however, typically arise in areas of relatively unremarkable gastric mucosa and are generally less aggressive than other adenoma subtypes. 5 These lesions are commonly associated with hereditary tumor syndromes such as familial adenomatous polyposis but can also occur sporadically. 6 Equally as rare are gastric neuroendocrine tumors (GNETs) which arise from the enterochromaffin-like cells of the stomach and are typically classified into 3 subgroups according to the background gastric pathology.…”