A rare cause of gastric outlet obstruction: gastritis cystica profunda accompanied by adenocarcinoma

Abstract

A 51-year-old woman without previous history of gastric surgery presented with repeated episodes of vomiting over the past several days. Gastrointestinal endoscopy revealed a gastric outlet obstruction caused by a 7-cm submucosal tumor in the prepyloric region (• " Fig. 1). Computed tomography and ultrasonography revealed a mass comprising several cysts, the largest of which was 6 cm in diameter. These examinations did not show any solid areas or the wall thickness of the cysts. Endoscopic ultrasonography revealed a multicystic mass in the submucosal layer (• " Fig. 2). Endoscopic ultrasound-guided fine-needle aspiration of the largest cyst produced serous fluid. Analysis of the aspirated fluid showed: CA19-9 4.7 × 10 6 U/mL, carcinogenic embryonic antigen 23 × 10 3 U/mL, amylase 3 IU/l, and no lipase (0 IU/L). A distal gastrectomy was carried out and macroscopic evaluation of the resected stomach revealed a large cyst with a solid portion and adjacent smaller cysts. Microscopically, the cysts were lined by MUC5AC-positive epithelium, which was partially proliferating in a papillary manner; the solid portion comprised proliferative MUC5AC-positive atypical cells infiltrating the subserous layer (• " Fig. 3).

Gastritis cystica profunda: Endoscopic ultrasound findings and review of the literature

“…[234678910111213141516] Table 1 summarizes details regarding demographics, endoscopic and EUS findings and subsequent clinical course of all these cases, including our case. The most frequent EUS feature of GCP was multiple anechoic cystic spaces/cysts in the submucosal in these cases.…”

Gastritis cystica profunda recurrence after surgical resection: 2-year follow-up

“…GCP can cause massive upper gastrointestinal hemorrhages in some cases [12,13], and it may be a cause of gastric outlet obstruction when accompanied by adenocarcinoma [3]. EUS revealed a hypoechoic mass without clear margins in the submucosa in the present case, which differs from homogeneous, hypoechoic, and multilocular polypoid masses in other cases [1-3]. The diagnosis of GCP should be confirmed by histological examination.…”

“…GCP seemed to be limited to previously operated stomachs in prior reports, but it has been found in unoperated stomachs in several recent articles [1-3]. Here, we report a case of GCP that occurred in a patient who had not previously undergone gastric surgery, and the GCP recurred in just 6 months after surgical resection.…”

“…The lesion usually occurs at gastroenterostomy sites; however, it has also been found in the stomachs of patients who have not previously undergone gastric surgery in several other articles [1-3]. GCP tends to occur more frequently in the presence of gastric cancers [2,3,5-8]; in a pathological study of 10,728 patients with gastric cancer, it was found in 161 patients [8]. There are some reports of GCP coexisting with Ménétrier disease (MD) [9,10] or gastric inverted hyperplastic polyps (IHP) [11].…”

“…Its malignant potential should be valued because GCP accompanied by gastric adenocarcinoma has been documented in several reports [2,3,5-8]. Ten-year follow-up of a case with GCP in an unoperated patient revealed low-grade dysplasia, and the sizes of both the GCP and the adenoma overlying it increased during the follow-up period [14].…”