Gastric adenocarcinoma of fundic gland type: Five cases treated with endoscopic resection

Abstract

Recently, a new disease entity termed gastric adenocarcinoma of fundic gland type (GA-FG) was proposed. We treated five cases of GA-FG with endoscopic submucosal dissection. All tumors were small and located in the upper third of the stomach. Four tumors were macroscopically identified as 0-IIa and one was identified as 0-IIb. Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder. All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion. Lymphatic invasion was seen only in one case, while no venous invasion was recognized. All tumors were positive for pepsinogen-I and MUC6 by immunohistochemistry. None showed p53 overexpression, and the labeling index of Ki-67 was low in all cases. All cases have been free from recurrence or metastasis. Herein, we discussed the clinicopathological features of GA-FG in comparison with past reports.

Distinct Involvement of the Sonic Hedgehog Signaling Pathway in Gastric Adenocarcinoma of Fundic Gland Type and Conventional Gastric Adenocarcinoma

“…In our study, H. pylori infection status was investigated by a serological analysis of anti- H. pylori immunoglobulin G titers or the 13 C urea breath test in patients with GAFG. Among 20 patients with GAFG examined by the H. pylori test, only one case (5%) was positive for H. pylori infection, in accordance with previous results [22,23]. Although some reports have demonstrated the effectiveness of the ABC method as a tool for determining the risk of gastric cancer [24,25], it is important to consider that group A may include patients with H. pylori -negative gastric cancers such as GAFG.…”

“…Therefore, these patients are assumed to have neither H. pylori infection nor atrophic gastritis and are at very little risk of developing gastric cancer. However, GAFG development appears to be independent of H. pylori infection [22,23]. In our study, H. pylori infection status was investigated by a serological analysis of anti- H. pylori immunoglobulin G titers or the 13 C urea breath test in patients with GAFG.…”

Gastric Adenocarcinoma of the Fundic Gland Type Treated by Endoscopic Mucosal Resection: A Case Report and Review of the Literature

“…Previous publications have also reported submucosal invasion as well as lymphovascular invasion [6, 9]. Given these features, we agree with earlier authors in their description of this entity as a carcinoma, albeit one with low metastatic potential [2–10].…”

“…Most GA-FGs are less than 1.5 cm and are amenable to endoscopic resection by either mucosal resection or submucosal dissection [2, 5, 9, 10]. In our patient, the lesion was fully excised by endoscopic mucosal resection.…”

“…Microscopically, the tumor cells mimic benign fundic gland epithelium and show abundant oxyntic cytoplasm with only mild nuclear atypia [2–11]. These lesions often show disruption of the muscularis mucosa with submucosal invasion but only rarely demonstrate lymph-vascular invasion [6, 9]. GA-FGs maintain a gastric immunophenotype, with features overlapping between fundic gland mucous neck cells and chief cells [2–11].…”