Gastric adenocarcinoma of the fundic gland type (chief cell predominant type)

Abstract

Gastric adenocarcinoma of the fundic gland (chief cell predominant type, GA-FG-CCP) was recently proposed as a new, rare variant of gastric adenocarcinoma. The aim of the current study was to evaluate the endoscopic features of GA-FG-CCP. A total of 10 GA-FG-CCPs were included and evaluated retrospectively. The endoscopic and clinicopathological features of the lesions were analyzed to provide information of diagnostic value. The GA-FG-CCPs were classified into two categories: submucosal tumor shape (60 %) and flat or depressed type (40 %). Endoscopically, the most common features were submucosal tumor shape (60 %), whitish color (70 %), dilated vessels with branching architecture (50 %), and background mucosa without atrophic change (90 %). GA-FG-CCP has distinct endoscopic characteristics, especially in terms of shape, color, vessels, and background mucosa and may be classified into two categories macroscopically. To diagnose GA-FG-CCP correctly by pathological examination of biopsy specimens, these endoscopic features should be taken into consideration.

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

“…The neoplastic glands are reactive for MUC6 and pepsinogen-I and nonreactive for MUC2 and MUC5AC, consistent with gastric rather than intestinal differentiation. As with most of other described cases [5, 10], there was no evidence of H. pylori infection, either on routine histology or by immunohistochemistry.…”

“…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.…”

“…Margins were negative and no recurrence has been reported more than one year later. In one case series including ten cases from the United States, only one case had persistence of tumor following endoscopic resection [11], and this was due to incomplete initial removal of tumor; all other patients with available follow-up data showed no evidence of disease at the most recent follow-up visit after 6 to 57 months from the removal of tumor [2, 5, 9–11]. One case report, however, has discussed more aggressive lesion with a large tumor measuring 4.4 cm in greatest dimension and extensive lymph-vascular invasion [6].…”