Early gastric cancer on submucosal heterotopic gastric glands

Hashimoto, Rintaro; Hamamoto, Hidetaka; Omori, Yuko; Tanuma, Tokuma

doi:10.1016/j.gie.2016.05.002

Cited by 8 publications

(7 citation statements)

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“…In the case of gastric cancer originated from SHGG is difficult to diagnose, because cancer exists at the submucosa, and cancer components are not exposed on the surface (14). Endoscopic ultrasonography (EUS) is considered a useful modality for both detecting SHGG and judging the depth of lesion invasion, because it can reveal hypoechoic scattered cystic lesions within a heterogeneous area (13,15). In the present case, the pathologic evaluation led to a diagnosis of SHGG after surgery.…”

Section: Discussionmentioning

confidence: 99%

Early gastric cancer with multiple submucosal heterotopic gastric gland: A case report

Namikawa¹,

Ishida²,

Yokota³

et al. 2019

mol clin onc

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A case of early gastric cancer involving multiple submucosal gastric glands that was treated by distal gastrectomy was described in the present case report. An 85-year-old man was referred to our hospital for the treatment of gastric cancer. Esophagogastroduodenoscopy revealed an irregular, nodular, elevated lesion on the posterior wall of the middle third of the stomach, and biopsy specimens indicated well-differentiated tubular adenocarcinoma. Submucosal tumor (SMT)-like lesions were detected in the area adjacent to the nodular lesion, in the anterior wall side of the middle third of the stomach. Abdominal contrast-enhanced computed tomography showed cystic lesions in the middle part of the stomach, and no mass lesions in the liver. The patient underwent distal gastrectomy with regional lymphadenectomy. Macroscopic examination of the resected specimen showed an SMT-like lesion measuring 2.8×2.6 cm in contact with a superficial, depressed lesion measuring 1.7×0.9 mm in the middle third of the stomach, and another SMT-like lesion measuring 1.5×1.4 cm in diameter, which was also in the middle third of the stomach. The pathological diagnosis was well-differentiated tubular adenocarcinoma invading the gastric submucosal layer without lymph node metastasis, but with nearby submucosal heterotopic gastric gland (SHGG) detected. Following surgery, the patient remained symptom-free without evidence of recurrence for 3 months. The finding of SHGG remains a rare entity, and further studies are warranted to clarify the association between these submucosal lesions and the development of cancer.

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Section: Discussionmentioning

confidence: 99%

Early gastric cancer with multiple submucosal heterotopic gastric gland: A case report

Namikawa¹,

Ishida²,

Yokota³

et al. 2019

mol clin onc

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“…The mechanism of SMT-like gastric cancer development is obscure, but several pathologic mechanisms have been suggested. These mechanisms include the biologic tendencies of poorly differentiated adenocarcinomas to exhibit invasion of a deeper layer at an early stage, marked lymphocyte infiltration around tumors[ 1 ], the production of large amounts of mucin by mucinous adenocarcinoma[ 10 , 11 ], substantial amounts of surrounding fibrosis due to repetitive inflammation, abundant edematous fibrosis[ 13 ], and adenocarcinomas arising from a submucosal heterotopic gastric gland[ 9 , 14 ], which have been recognized as aberrant lamina propria components associated with repeated erosion and regeneration. These factors may facilitate a predominance of submucosal growth and penetration of muscularis mucosa during the early stage of carcinogenesis and contribute to a macroscopic appearance indistinguishable from SMT.…”

Section: Discussionmentioning

confidence: 99%

Early gastric cancer presenting as a typical submucosal tumor cured by endoscopic submucosal dissection: A case report

Cho¹,

Lee²

2022

WJG

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BACKGROUND Submucosal tumor (SMT)-like gastric cancer is rare, and almost all cases undergo curative surgical treatment because the submucosal layer is usually deeply invaded by tumor cells or because histopathologic types of SMT-like gastric cancer are undifferentiated or poorly differentiated. No report has been issued on an SMT-like gastric cancer cured by endoscopic resection alone or on changes in the endoscopic features of this type of tumor over several years. CASE SUMMARY We describe an exceptional case of a 53-year-old male with a 1.5 cm-sized SMT-like lesion covered by normal-appearing mucosa discovered by esophagogastroduodenoscopy (EGD) at the gastric antrum. Endoscopic ultrasound (EUS) visualized a homogeneous, well-circumscribed hypoechogenic lesion arising from the second sonographic layer with associated subtle obliteration of the third sonographic layer. Initial endoscopic biopsy was negative for neoplasm. The patient refused to undergo an invasive procedure and was subsequently lost to follow-up. Three years after initial detection, EGD revealed the lesion had become markedly erythematous, and at 4 years after initial EGD it had increased in size to 1.8 cm and developed a central ulcer and a heterogeneous EUS echo. Finally, endoscopic submucosal dissection (ESD) was performed, and histopathologic examination revealed a moderately differentiated adenocarcinoma had minutely invaded the submucosal layer (invasion depth 169 μm) but without lymphovascular invasion and with negative resection margins. Fortunately, no additional surgical treatment was required. He has been followed for 4 years after ESD without any evidence of local or distant recurrence. CONCLUSION This report describes an extremely rare case of early gastric cancer presenting as SMT that was cured by ESD after a treatment delay of 4 years and the endoscopic changes that occurred during this period. The report highlights the importance of considering the possibility of gastric cancer when SMT is encountered in clinical practice.

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“…Since GHIP presents as an SMT‐like lesion covered with normal gastric mucosa, assessment by EUS is useful for detecting GHIP and visualizing hyperechoic lesions, including small cystic hypoechoic spots, in the third layer. 8 However, EUS alone may be insufficient for distinguishing carcinoma from non‐neoplastic GHIP. In this case, M‐NBI was useful for diagnosis since it could detect an irregular microsurface pattern and enable a targeted biopsy‐diagnosed carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Gastric adenocarcinoma arising from hamartomatous inverted polyp during 8‐year follow‐up

et al. 2021

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Gastric hamartomatous inverted polyp (GHIP) is rare, with few reports of carcinogenesis from GHIP during long‐term follow‐up. A 51‐year‐old woman was diagnosed as having a submucosal tumor (SMT) during esophagogastroduodenoscopy (EGD) in 2008. In 2016, although the size and height of the lesion had not changed, she was referred to our hospital for further investigation of the lesion. EGD depicted a gastric SMT of 20 mm in diameter in the greater curvature of the upper gastric body, and a biopsy specimen showed a well to poorly differentiated adenocarcinoma. Following successful laparoscopic total gastrectomy, histopathological examination revealed an intramucosal adenocarcinoma arising in GHIP.

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Early gastric cancer on submucosal heterotopic gastric glands

Cited by 8 publications

References 0 publications

Early gastric cancer with multiple submucosal heterotopic gastric gland: A case report

Early gastric cancer with multiple submucosal heterotopic gastric gland: A case report

Early gastric cancer presenting as a typical submucosal tumor cured by endoscopic submucosal dissection: A case report

Gastric adenocarcinoma arising from hamartomatous inverted polyp during 8‐year follow‐up

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