Clinicopathological and Endoscopic Features of Raspberry-Shaped Gastric Cancer in Helicobacter pylori-Uninfected Patients

Abstract

<b><i>Background:</i></b> Gastric adenocarcinoma of foveolar type (GA-FV) is a raspberry-shaped gastric cancer (RSGC) and garners much attention as <i>H. pylori</i> (<i>Hp</i>)-uninfected gastric cancer. However, the classification and clinicopathological and endoscopic features of RSGCs in <i>Hp</i>-uninfected patients are poorly defined. We designed a new histopathological classification of RSGC and compared them via endoscopic and clinicopathological characteristics. <b><i>Summary:</i></b> From 996 patients with early gastric cancers resected by endoscopy in our hospital, we studied 24 RSGC lesions from 21 (2.4%) <i>Hp</i>-uninfected patients. RSGCs were classified into 3 histological types as follows: GA-FV (<i>n</i> = 19), gastric adenocarcinoma of fundic gland type (GA-FG, <i>n</i> = 2), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM, <i>n</i> = 3). Most of the lesions were found at the greater curvature of the upper or middle third of the stomach. GA-FV lesions were homogeneously reddish and frequently accompanied with a whitish area around the tumor and an irregular microvascular (MV) pattern; these features were confirmed histopathologically by the presence of homogeneous neoplastic foveolar epithelium with foveolar hyperplasia around the tumors. GA-FG lesions might be heterogeneously reddish with a submucosal tumor shape and regular MV pattern; these were confirmed by the presence of covered or mixed nonneoplastic epithelium on deeper regions of tumors. GA-FGM lesions might be homogeneously reddish and occasionally had a submucosal tumor shape and irregular MV pattern; these were confirmed by the presence of homogeneous neoplastic foveolar epithelium on deeper regions of the tumors. <b><i>Key Messages:</i></b> RSGCs in <i>Hp</i>-uninfected patients are classified into 3 histopathological types. For accurate diagnosis of RSGCs, it may be necessary to fully understand endoscopic features of these lesions based on these histological characteristics and to take a precise biopsy.

Endoscopic Features of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage

“…However, it is necessary to understand the characteristics of each type, since these findings tend to be few for GA-FG, which has an atypical color and morphology, such as a reddish color and flat or depressed type. In particular, reddish and of an elevated type lesions ( Figure 4 a–c) required differentiation from a gastric foveolar-type adenoma (raspberry-shaped gastric cancer in Japan) [ 24 , 25 ]. In contrast, the percentage of GA-FGM lesions showing the above four features was generally low.…”

A rare case of Helicobacter pylori–uninfected foveolar-type gastric cancer with submucosal invasion and lymph node metastasis

“…Although H. pylori –uninfected GC is reported to account for less than 1% of all GCs, 1 its incidence has varied widely from 0.66% to 14% in previous reports. 6 – 11 The incidence of H. pylori infection is decreasing rapidly in younger age groups, and the number of reports of H. pylori –uninfected GC is expected to relatively increase in the future. Although a definition of H. pylori –uninfected GC has yet to be established, Matsuo et al 1 defined it as a case in which (1) two or more diagnostic methods (such as serum H. pylori antibody and stool, urine, and UBTs) are negative, (2) histopathological examination shows no gastritis, and (3) endoscopic examination shows no atrophy (with RAC).…”

“…Sato et al 7 reported four further cases, including the intestinal type. In recent years, there have been increasing reports of foveolar-type tumors characterized by small reddish elevated lesions, 8 , 9 which Nomura et al 10 called “raspberry-like” tumors because of their morphology. The location of GC was divided into the upper one-third (U), middle one-third (M), and lower one-third (L) of the stomach.…”

Pathological Diversity of Gastric Cancer from the Viewpoint of Background Condition

“…Immunohistochemically, tumor cells were positive for MUC5AC and negative for MUC6, MUC2, or CD10. Although the Ki67 index was relatively high, p53-positive cells were scattered in the tumor (wild-type pattern) [26]. Although some reports describe these neoplasms as adenocarcinoma, some authors describe these neoplasms as “adenoma” because of their low malignant potential [27].…”