Abstract
In this report, we describe two patients with white globe appearance in the non-cancerous stomach. The patient in Case 1 was an 82-year-old Japanese man who had been taking vonoprazan, dimethicone, acotiamide, sitagliptin, candesartan, dutasteride, etizolam and zolpidem. The patient in Case 2 was a 74-year-old Japanese woman who had been taking esomeprazole, rebamipide, sitagliptin, candesartan, ezetimibe, mirabegron, levocetirizine, zolpidem and lactobacillus preparation. In both cases, endoscopy revealed multiple white spots in the stomach. Magnifying endoscopy and blue laser imaging revealed a slightly elevated, round, white substance. Biopsied specimens from the lesions contained parietal cell protrusions and fundic gland cysts. Intraglandular necrotic debris was absent. Consequently, microscopic features in these cases were different from those reported previously for white globe appearance observed in gastric cancer lesions. These results indicate that white globe appearance can be observed in non-cancerous stomach. Although the macroscopic features could be confusing or misleading, thorough endoscopic observation and pathological analysis of white globe appearance will aid oncologists and endoscopists in differentiating between cancer-related lesions and non-cancerous lesions.
Highlights
White globe appearance was first reported in 2015 by Doyama et al [1] as a small, white lesion in the gastric mucosa
It is noteworthy that the white globe appearance is found within the margin of the cancerous gastric epithelium
We present two patients with multiple white spots in the non-cancerous gastric mucosa, which were consistent with the known features of the white globe appearance
Summary
White globe appearance was first reported in 2015 by Doyama et al [1] as a small, white lesion in the gastric mucosa. The presence of white globe appearance in the stomach has been reported to be highly indicative of cancer [1] It can be observed in non-cancerous gastric mucosa, albeit rarely [3]. We present two patients with multiple white spots in the non-cancerous gastric mucosa, which were consistent with the known features of the white globe appearance. Biopsy from the gastric mucosa that contained white spots revealed cystic dilation of the gastric fundal gland with a 400 μm diameter (Figure 2a, b). A 74-year-old Japanese woman underwent esophagogastroduodenoscopy for investigation of epigastric pain and throat discomfort She had been taking esomeprazole, rebamipide, sitagliptin, candesartan, ezetimibe, mirabegron, levocetirizine, zolpidem and lactobacillus preparation for reflux esophagitis, diabetes, hypertension, hyperlipidaemia, urticaria and insomnia. Parietal cell protrusions and dilated glands forming microcysts were present (Figure 4c)
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