Two Atypical Cases of Nodular Gastritis: A Poorly Differentiated Gastric Adenocarcinoma and a Pseudo-Low Grade Gastric MALT Lymphoma

Abstract

Nodular gastritis is a Helicobacter pylori-related gastritis with endoscopically proven gooseflesh skin-like nodularity in the gastric antrum. Although an association between nodular gastritis and gastric malignancies has been suggested, there is neither a treatment strategy nor a treatment guideline for this condition because of its relative rarity. We have recently experienced two cases of diffuse-type nodular gastritis invading both the antrum and corpus of the stomach with atypical findings that required specific treatments in two young females. The first patient was diagnosed with a suspicious low grade gastric mucosa associated lymphoid tissue (MALT) lymphoma lesion on a diffuse-type nodular gastritis, and was cured by H. pylori eradication. The second patient was diagnosed with a signet cell type gastric cancer on a diffuse-type nodular gastritis, and was cured by surgical resection. When considering the nature and significance of these gastric lesions, a link between nodular gastritis and gastric malignancy should be considered, especially in young women who have diffuse-type nodular gastritis involving both the antrum and corpus of the stomach.

Future candidates for indications of Helicobacter pylori eradication: Do the indications need to be revised?

“…In a Japanese study, 0.19% of the general population showed nodular gastritis on routine endoscopic examination, and all had H. pylori infection 8 . It seems that when a new onset of H. pylori infection occurs in adults, some individuals show an immature and aggressive tissue response 9 . Some may progress to a diffuse‐type nodular gastritis (Fig.…”

“…A few cases of diffuse‐type nodular gastritis may progress further to gastric neoplasm, especially in young women due to fewer atrophic changes. Adapted from Choi et al ., 9 with permission. …”

“…(c) Indigo carmine chromoendoscopy conducted 3 months after successful H. pylori eradication revealed diminished nodular elevations. Adapted from Choi et al ., 9 with permission. …”

Endoscopic Gastritis: What Does It Mean?

“…Whitish patches, whitish plaques, and homogeneous whitish discoloration on the endoscopic findings suggesting metaplastic gastritis are more prominent in chromoendoscopic findings using 1.5% acetic acid mixed with 0.2% indigo carmine (b) than in those findings before applying chromoendoscopy (a) dominant, poorly differentiated or signet ring cell type gastric cancer, and pangastritis leading to an advanced stage scirrhous cancer (so called Borrmann type IV cancer) that usually invades the greater curvature side of the corpus [10]. We have recently reported cases of nodular gastritis in young women with atypical findings who required specific treatment for their gastric lesions [11]. Our findings suggest that, in contrast to cases in children, novel H. pylori infection may lead to nodular gastritis in some adults, and some may progress to diffuse-type nodular gastritis that invades both the antrum and body of the stomach.…”

“…For example, erosive gastritis is linked to obesity and hypoadiponectinemia [3], whereas open-type atrophic gastritis, metaplastic gastritis, and nodular gastritis are linked to gastric cancer [6][7][8][9][10][11][12][13][14]. Therefore, one must pay attention to the diagnostic features of gastritis during the endoscopic examination.…”