Gastritis cystica polyposa associated with a gastric stump carcinoma, with special reference to cell kinetics and p53 gene aberrations

Abstract

We report a case of gastritis cystica polyposa (GCP) that developed in association with a small stump carcinoma. The patient had had distal gastrectomy for peptic ulcer 33 years prior to the present illness. Total gastrectomy was carried out for the stump carcinoma of the remnant stomach, followed by Roux-en-Y anastomosis. Histological examination revealed that the cancer was associated with a GCP lesion in its neighborhood. The resected stomach was subjected to a cell kinetics study and p53 gene analysis, as GCPs are thought to have a high potential for carcinogenesis. The GCP mucosae, as well cancer tissues and remnant mucosae obtained from the same specimens, were investigated and compared. We found that cell kinetics, as measured by a Ki-67 labeling index count, was more accelerated in the GCP than in the remnant mucosa, and that p53 gene aberrations, including both mutations and deletions, took place in the GCP lesion. As the p53 gene is considered to be recessive, in principle, its tumor suppressive activity is lost only when gene aberration, either mutation or deletion, occurs concurrently or successively in both alleles. It was of interest to us that a benign lesion such as GCP had, in this instance, already developed both gene aberrations, strongly suggesting a precancerous nature for this disease.

Epstein-Barr virus-associated gastric carcinoma in the remnant stomach: de novo and metachronous gastric remnant carcinoma

“…22,23 High cell proliferation activity in the epithelium of GCP has been reported. 24,25 The reflux of bile and pancreatic juice is considered to cause regenerative atypia and cell proliferation in epithelial cells, resulting in the formation of GCP. 25,26 This is in contrast to observations in the non-remnant stomach, i.e., marked atrophy and moderate-to-marked lymphocytic infiltration are characteristic of EBV-associated GC.…”

Imaging, endoscopy, and pathologic findings of primary gastritis cystica polyposa: description of a rare entity in a small case series

“…The solid portion was relatively obvious (mucosal polypoid hyperplasia) and was often accompanied by fine pointlike cystic changes internally [4][5][6][7][8][9][10]12]. However, this cohort only had one case similar to the reports in the literature, whereas the remaining cases were primarily dominated by the cystic component, with thick mucosal hyperplasia on the surface.…”

“…Pathogenesis of GCP is still elusive. It is reported that inflammatory infiltration and intestinal reflux may be the primary pathogenetic mechanisms [7]. However, only a few reports have presented imaging findings of primary GCP that was not associated with a history of gastrointestinal surgery.…”

“…Recurrent cysts are part of a very rare congenital disease and mainly occur in the serosa; the cysts are visible on endoscopic ultrasound and mainly present as hyperechoic mucosa in the inner cystic wall surrounded by a hypoechoic muscle layer [7]. The imaging findings of stromal tumors are complicated and difficult to identify; however, only 14% of stromal tumors reported in the literature contain a polypoid-like tubular structure [11], and most cases demonstrate a large lesion with cystic necrosis as well as many solid components and irregular cystic regions.…”

Gastritis Cystica Polyposa Concomitant with Gastric Inflammatory Fibroid Polyp Occurring in an Unoperated Stomach

“…Koga et al described that there were 4 cases of GCP (9.5%) in their 42 patients who had once undergone gastrojejunostomy and received further surgery on account of various reasons (9). In Japan, there are many reports describing the association of GCP with early or small cancerous lesions in the remnant stomach (11,12). Thus GCP has been proposed to be a possible precancerous lesion itself (13).…”