Multiple gastric adenocarcinoma of fundic gland type: A case report

Abstract

BACKGROUNDIn recent years, there have been reports of a new histological type of gastric cancer, termed gastric adenocarcinoma of the fundic gland (GA-FG). This disease entity presents differentiation towards the fundic gland, especially chief cell-predominant differentiation (GA-FG-CCP). GA-FG-CCP easily invades into the submucosa but rarely shows metastasis. The reports mostly describe primarily single lesions. Herein, we report a case with multiple lesions, and summarize the clinicopathologic characteristics of multiple cases.CASE SUMMARYA 55-year-old woman underwent upper gastrointestinal endoscopy screening. Two whitish lesions on the anterior wall of the gastric corpus and the gastric fundus were detected. The patient had previously received Helicobacter pylori eradication therapy. The mucosa was characterized as grade C-2 atrophic gastritis. We diagnosed the patient with multiple GA-FG (GA-FG-CCP) by hematoxylin and eosin (HE) staining and immunohistochemical staining of the endoscopic biopsy. Upon performing endoscopic submucosal dissection (ESD), one lesion was not found, but the scar from the biopsy was visible; the mucularis mucosa of the biopsy and ESD-resected specimen were intact. The two lesions showed no lymphatic nor venous invasion. The resection performed appeared to be relatively curative.CONCLUSIONCases of multiple GA-FG-CCP are very rare in clinical practice. Most of its clinicopathologic characteristics are similar to those of a single lesion. Our case provides diagnostic and therapeutic information about GA-FG-CCP with multiple lesions.

Gastric adenocarcinoma of the fundic gland type: clinicopathological features of eight patients treated with endoscopic submucosal dissection

“…Most cases, including those we evaluated, were instances of solitary tumors. Cases of multiple GA-FG have been rare, and most of their clinicopathological characteristics were similar to those seen in single lesions [ 5 ].…”

“…Subsequently, Ueyama proposed a new histological type of gastric cancer with differentiation toward the fundic gland, named “gastric adenocarcinoma of the fundic gland type” in 2010 [ 3 ]. In total, 112 cases had already been reported in English literature when the concept of GA-FG was first proposed [ 4 , 5 ]. The majority of GA-FG cases were observed in Asia (South Korea and Japan); however, cases were rare in other regions [ 6 ].…”

Histopathologic Change of a Case of Gastric Oxyntic Neoplasm (Gastric Adenocarcinoma of Fundic Gland Mucosa Type) Through 5 Years With Concurrent Other Oxyntic Gland Lesions

“…14 Another thing about the present case is that, other than the main hill-like neoplasm, a prototypic GA-FG was incidentally found in the ESD specimen. Some cases with multiple GA-FG lesions have been reported, 15,16 which suggest the possible situation of the oxyntic gland mucosa vulnerable to GA-FG in some patients. If it would be the case for oxyntic gland neoplasms including GA-FGM that may be progressive and aggressive compared with GA-FG, sufficient surveillance is mandatory for patients with an oxyntic gland neoplasm.…”

Gastric adenocarcinoma of the fundic gland type: clinicopathological features of eight patients treated with endoscopic submucosal dissection

“…Based on the above parameters, we summarize the cardinal histopathologic features to diagnose GA-FG as follows: (1) GA-FG arise most commonly from the normal gastric mucosa of the fundic gland region without intestinal metaplasia; (2) the lesion is almost invariably lined on the surface with normal-appearing foveolar-type epithelium; (3) the lesion differentiates toward the fundic gland and mostly involves chief cell-predominant differentiation; (4) the lesion demonstrates a complex architectural pattern of glands: anastomosing cords, dilated glands, cribriform glands; the atypia of the tumor cell is usually mild; (5) the lesion often invade the submucosal layer.…”

“…Subsequently, Ueyama proposed a new histological type of gastric cancer with differentiation toward the fundic gland, named "gastric adenocarcinoma of the fundic gland type" in 2010 3 . In total, 112 cases had already been reported in English literature when the concept of GA-FG was rst proposed 4,5 . The majority of GA-FG cases were observed in Asia (South Korea and Japan); however, cases were rare in other regions 6 .…”