Pepsinogen I- and H+/K+-ATPase-immunohistochemical Positivity in Endoscopically Resected Early Gastric Neoplasia

Abstract

Gastric adenocarcinoma of the fundic gland type (GAFG) has been recently classified by the World Health Organization (WHO), however, clinicopathologic features of pepsinogen I-or H + /K + -ATPase-positive gastric tumors remain unclear. Therefore, this study evaluates the frequency and clinicopathologic features of those tumors, using a tissue microarray block to identify pepsinogen I-or H + /K + -ATPase-positive tumors from 810 endoscopically resected, early gastric epithelial tumors. The frequency of pepsinogen I-positive lesions was 2.1%, and that of H + /K + -ATPase-positive lesions was 2.0%. Pepsinogen I-or H + / K + -ATPase positivity was not observed in undifferentiated-type tumors, while gastric tumors with morphologic similarity to fundic glands were positive for pepsinogen I-or H + /K + -ATPase. We divided pepsinogen I-or H + /K + -ATPase-positive gastric tumors into group A, with fundic gland-like structure, or group B, without fundic gland-like structure. The frequency of group A was 1.6%: 46.2% were positive only for pepsinogen I and 53.8% for H + /K + -ATPase and pepsinogen I. The frequency of group B was 1.5%: 25% were positive only for pepsinogen I, 8.3% for H + / K + -ATPase and pepsinogen I, and 66.7% only for H + /K + -AT-Pase. The 2 tumor groups differed in location and endoscopic features. Hematoxylin and eosin staining showed that group B had more exposed tumors to the surface, larger nuclei, and more background atrophy than group A. Immunostaining showed significantly higher positivity rates for MUC5AC, CD10, CDX2, and p53 expression, and a higher Ki-67 labeling score. Our results provide novel insights into the pathology of early gastric tumors with histologic or immunohistochemical evidence of fundic gland differentiation.

Endoscopic features of oxyntic gland adenoma and gastric adenocarcinoma of the fundic gland type differ between patients with and without Helicobacter pylori infection: a retrospective observational study

“…Third, immunohistochemical studies were not performed for all patients. Although a diagnosis can essentially be made according to the WHO classification criteria [ 1 ], confirmation by positive immunohistochemical staining for both pepsinogen I and MUC6, as well as cell differentiation markers such as H+/K+-ATPase (parietal cell) and MUC5AC (foveolar epithelium), is preferable [ 5 – 7 ].…”

“…According to the World Health Organization (WHO) classification, a neoplasm confined to the mucosa is called an oxyntic gland adenoma, whereas a neoplasm with submucosal invasion is classified as GA-FG [ 1 ]. Since GA-FG was first described in a single case report in 2007 [ 4 ], this neoplasm has been predominantly observed as a subepithelial lesion in the upper third of the stomach during esophagogastroduodenoscopy [ 5 – 7 ]. However, some oxyntic gland adenomas and GA-FG present as flat lesions in other parts of the stomach.…”

Endoscopic Features of Oxyntic Gland Adenoma and Gastric Adenocarcinoma of the Fundic Gland Type Differ Between Patients with and Without Helicobacter pylori Infection: A Retrospective Observational Study

“…Second, immunohistochemical studies were not performed for all patients. Although a diagnosis can essentially be made according to the WHO classi cation criteria [1], con rmation by positive immunohistochemical staining for both pepsinogen I and MUC6, as well as cell differentiation markers such as H+/K+-ATPase (parietal cell) and MUC5AC (foveolar epithelium), is preferable [5][6][7].…”

“…According to the World Health Organization (WHO) classi cation, a neoplasm con ned to the mucosa is called an oxyntic gland adenoma, whereas a neoplasm with submucosal invasion is classi ed as GA-FG [1]. Since GA-FG was rst described in a single case report in 2007 [4], this neoplasm has been predominantly observed as a subepithelial lesion in the upper third of the stomach during esophagogastroduodenoscopy [5][6][7]. However, some oxyntic gland adenomas and GA-FG present as at lesions in other parts of the stomach.…”

Comparison of Prognosis and Metachronous Gastric Tumor Rates After Endoscopic Submucosal Dissection Between Gastric Neoplasm of Fundic Gland Type Neoplasms and Conventional Gastric Adenocarcinoma

“…Gastric adenocarcinoma of the fundic gland type (GAFG) was first reported in 2010 as a new type of gastric cancer [1], and many reports on GAFG have since been published [2][3][4][5][6][7][8]. GAFG resembles a fundic gland with mild nuclear atypia [1].…”