Adenocarcinoma Of Fundic Gland Type Research Articles

White ring sign is useful for differentiating between fundic gland polyp and gastric adenocarcinoma of fundic gland type

Background: Gastric adenocarcinoma of fundic gland type (GA-FG) is characterized by an elevated lesion with vessel dilation exhibiting branching architectures (DVBA). However, this feature is also found in fundic gland polyp (FGP), posing a challenge in their differentiation. In this study, we aimed to investigate the clinicopathological features of gastric elevated lesions with DVBA and assess the efficacy of the white ring sign (WRS) as a novel marker for distinguishing between FGP and GA-FG. Methods: We analyzed 159 gastric elevated lesions without DVBA and 51 gastric elevated lesions with DVBA, further dividing the latter into 39 in the positive-WRS group and 12 in the negative-WRS group. The clinicopathological features, diagnostic accuracy, and inter-rater reliability were analyzed. Results: Univariate and multivariate analyses for gastric elevated lesions with DVBA identified the histological type consistent with FGP and GA-FG, along with the presence of round pits in the background gastric mucosa, as independent predictors. FGPs were present in 92.3% (36/39) of the positive-WRS group and GA-FGs were observed in 50.0% (6/12) of the negative-WRS group. Positive- and negative-WRS exhibited high diagnostic accuracy, with 100% sensitivity, 80.0% specificity, and 94.1% accuracy for FGP, and 100% sensitivity, 86.7% specificity, and 88.2% accuracy for GA-FG. Kappa values of WRS between experts and nonexperts were 0.891 and 0.841, respectively, indicating excellent agreement. Conclusions: Positive- and negative-WRS demonstrate high diagnostic accuracy and inter-rater reliability for FGP and GA-FG, respectively, suggesting that WRS is a useful novel marker for distinguishing between FGP and GA-FG.

Gastric adenocarcinoma of fundic gland type: a clinicopathological analysis of five cases

Gastric adenocarcinoma of fundic gland type: a clinicopathological analysis of five cases

Clinical and pathological characteristics of gastric adenocarcinoma of fundic gland type

To analyze the clinical, endoscopic and pathological feature of gastric adenocarcinoma of fundic gland type (GA-FG) (18 cases) collected from Sir Run Run Shaw Hospital, affiliated with Zhejiang University School of Medicine and Taizhou Hospital of Zhejiang Province from January 2019 to July 2022. There were 18 cases of patient of GA-FG, including male 12 cases, female 6 cases, aged from 38 to 78 years old, with average age of 60.5 years old. Gastroscopy showed that bulging or flat lesions of gastric fundus were 0.2-5.5 cm in size, and the mucosal surface was smooth, redness or rough. Histologic examination showed that tumor cells were dominated by chief cells and scattered with a few oxyntic cells, formed a complex gland that anastomoses each other, and infiltrated to the submucosa. The results of immunohistochemistry showed that tumor cells were positive for the expression of mucin-6 (MUC6) and Pepsinogen 1, and partial expression of synaptophysin (Syn). GA-FG is a rare type of gastric adenocarcinoma with good differentiation, and currently only a few cases have been reported, and often easily been misdiagnosed or missed. Therefore, to master the characteristics of clinic and pathology is helpful to improve the ability of clinical pathologists in differential diagnosis.

Synchronous gastric MALT lymphoma and gastric adenocarcinoma of fundic gland type arising from a hamartomatous inverted polyp in a Helicobacter pylori naive patient.

We present a rare case that showed the coexistence of gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma in Helicobacter pylori-naive stomach. A 72-year-old man was followed up after surgery for epithelial carcinoma of the glottis at the Department of Otolaryngology. He underwent an upper gastrointestinal endoscopy for an abnormal PET-CT accumulation, which revealed gastric adenocarcinoma of fundic gland type in the gastric fundus and MALT lymphoma in the upper gastric body. Hence, we performed an endoscopic submucosal dissection for gastric cancer and diagnosed gastric adenocarcinoma of fundic gland type derived from a hamartomatous-inverted polyp. Subsequently, Gastric MALT lymphoma was treated with radiation therapy because the API2-MALT1 gene was positive and the Helicobacter pylori infection was negative. A complete response was observed. Even in Hp-naive stomachs, cases such as the present case are complicated by special types of gastric cancer and MALT lymphoma, and endoscopic examination should be performed with these diseases in mind.

Gastric inverted hyperplastic polyp with typical endoscopic feature.

A 37-year-old woman received gastroscopy for compliant of upper abdominal discomfort for six months. A polyp with size in 10 mm was found in the upper third of stomach. The polyp with a papilla-like depression in the top and smooth surface similar to surrounding non-atrophic mucosal characterized by regular arrangement of collective veins (Fig. 1A and B). Endoscopic ultrasound showed the lesion was hypo –equal echo in the mucosal layer, displayed expansive growth nature and oppressing submucosal layer (Fig. 1C). Histology of biopsy showed inflamed mucosa with submucosal atypic oxyntic gland, considering histological diagnosis of ectopic gastric glands with atypia, but adenocarcinoma of fundic gland type cannot be ruled out (Fig. 1D and E). Thus, the polyp was removed by endoscopic submucosal dissection for accurate histological diagnosis. The histology showed the benign hyperplastic glands with inverted growth manner with communication with mucosal at the top, the surround area was covered by normal oxyntic mucosa (Fig. 2), and diagnosed as gastric inverted hyperplastic polyp (GIHP). GIHPs are rare gastric polyps and typically appeared as rounded subepithelial lesions with normal overlying mucosa, more than half of cases with surface erosion, depression, or orifice exuding mucin [ [1] Kim JY Ahn S Kim KM et al. Gastric inverted polyps—distinctive subepithelial lesions of the stomach: clinicopathologic analysis of 12 cases with an emphasis on neoplastic potential. Am J Surg Pathol. 2021 May 1; 45: 680-689 Crossref PubMed Scopus (3) Google Scholar ]. GIHPs had the potential to develop adenocarcinoma, but histological diagnosis based on biopsy is challenging, endoscopic resection may be a wise choice for accurate diagnosis. Fig. 2Histology based on the resected specimen. (A) Scanning image of the lesion showed inverted growth manner; (B) Hyperplastic glands without dysplasia at high magnification. View Large Image Figure Viewer Download Hi-res image

Clinicopathological features of gastric adenocarcinoma of fundic gland type

Clinicopathological features of gastric adenocarcinoma of fundic gland type

Three-arm endoscopic mucosal resection for gastric adenocarcinoma of fundic gland type.

A 65-year-old man was diagnosed with intramucosal carcinoma by endoscopy and pathological biopsy; the tumor was 10 mm in size and located in the greater curvature of the gastric body ([Fig. 1 a]). It was difficult to perform endoscopic submucosal dissection (ESD) on the greater curvature of the gastric body. We therefore proposed a three-arm endoscopic mucosal resection (TA-EMR) technique in which two nasal oxygen tubes, about 80 cm in length, were taped to the outside of the endoscope to become a double additional working channel (AWC) ([Video 1]).

S3082 A Rare Case of Gastric Adenocarcinoma of Fundic Gland Type in a White American Male

S3082 A Rare Case of Gastric Adenocarcinoma of Fundic Gland Type in a White American Male

Gastric adenocarcinoma of fundic gland type with two closely located lesions endoscopically resected en masse.

Gastric adenocarcinoma of fundic gland type with two closely located lesions endoscopically resected en masse.

Clinicopathological and Endoscopic Features of Raspberry-Shaped Gastric Cancer in Helicobacter pylori-Uninfected Patients

Background: Gastric adenocarcinoma of foveolar type (GA-FV) is a raspberry-shaped gastric cancer (RSGC) and garners much attention as H. pylori (Hp)-uninfected gastric cancer. However, the classification and clinicopathological and endoscopic features of RSGCs in Hp-uninfected patients are poorly defined. We designed a new histopathological classification of RSGC and compared them via endoscopic and clinicopathological characteristics. Summary: From 996 patients with early gastric cancers resected by endoscopy in our hospital, we studied 24 RSGC lesions from 21 (2.4%) Hp-uninfected patients. RSGCs were classified into 3 histological types as follows: GA-FV (n = 19), gastric adenocarcinoma of fundic gland type (GA-FG, n = 2), and gastric adenocarcinoma of fundic gland mucosa type (GA-FGM, n = 3). Most of the lesions were found at the greater curvature of the upper or middle third of the stomach. GA-FV lesions were homogeneously reddish and frequently accompanied with a whitish area around the tumor and an irregular microvascular (MV) pattern; these features were confirmed histopathologically by the presence of homogeneous neoplastic foveolar epithelium with foveolar hyperplasia around the tumors. GA-FG lesions might be heterogeneously reddish with a submucosal tumor shape and regular MV pattern; these were confirmed by the presence of covered or mixed nonneoplastic epithelium on deeper regions of tumors. GA-FGM lesions might be homogeneously reddish and occasionally had a submucosal tumor shape and irregular MV pattern; these were confirmed by the presence of homogeneous neoplastic foveolar epithelium on deeper regions of the tumors. Key Messages: RSGCs in Hp-uninfected patients are classified into 3 histopathological types. For accurate diagnosis of RSGCs, it may be necessary to fully understand endoscopic features of these lesions based on these histological characteristics and to take a precise biopsy.

Gastric Adenocarcinoma of Fundic Gland Type Treated by Endoscopic Submucosal Dissection

Gastric adenocarcinoma of fundic gland type is known to originate from the gastric mucosa of the fundic gland region without intestinal metaplasia. It is difficult to detect during endoscopy and diagnose histopathologically. The development of immunohistochemistry has enabled the diagnosis of gastric adenocarcinoma of fundic gland type by gastric phenotype. A 34-year-old man visited us for treatment of a 5 cm-sized low-grade dysplasia in the gastric fundus which was incidentally found during a health check-up endoscopy. Endoscopic submucosal dissection was performed successfully, and the final histopathology showed gastric adenocarcinoma of fundic gland type. Herein, we report a rare case of gastric adenocarcinoma of fundic gland type and its endoscopic and histopathologic findings.

Two patients with gastric adenocarcinoma of fundic gland type (GAFG) who previously underwent endoscopic submucosal dissection (ESD) for a common type of gastric carcinoma.

Two patients with gastric adenocarcinoma of fundic gland type (GAFG) who previously underwent endoscopic submucosal dissection (ESD) for a common type of gastric carcinoma.

178P - Chief cell in stomach have stem cell activity and potential to develop gastric cancer

BackgroundRapidly proliferating stomach stem cells have been predicted to be located at the isthmus of both corpus and antrum. We recently identified such stem cells by using 270 bp Runx1 enhancer element, eR1 (Gastroenterol, 2017). In addition, eR1 also marked small number of fully differentiated chief cells in the corpus. We investigated whether chief cells have stem cell activity and can be an origin of gastric cancer, particularly because there are disagreements among the researchers. MethodsWe generated knock-in mice of pepsinogen C-CreERT2 and crossed them with Rosa26-EYFP mice or pepsinogen A-CreERT2 and crossed them with Rosa26-tdTomato mice for lineage tracing. PGC-CreERT2 mice were also crossed with K-rasG12D/+, Trp53flox/flox and Apcflox/floxmice for carcinogenesis model. Those mice were injected with Tamoxifen 2 mg alternate days for 6 timesto activate Cre recombinase in the chief cells. ResultsBy activating Cre recombinase, we showed that relatively small number of chief cells was retro-differentiated into neck, parietal, pit and enteroendocrinecells suggesting that chief cells underwent differentiation in exact reverse order to make a complete gland unit. When K-rasG12Dwas activated by pepsinogen C-CreERT2, induction of metaplasia was observed. Addition of p53 knockout with K-rasG12Dinto chief cells showed increasing number of glands with metaplasia. Furthermore, addition of APC knockout combination with K-rasG12Dand p53f/fshowed invasive intestinal type gastric cancer in the corpus. These results suggest that at least small subfraction of chief cell have stem cell activity and potential to give rise to gastric cancer. Recently, new entity of gastric adenocarcinoma has been proposed which called Gastric adenocarcinoma of fundic gland type (chief cell predominant type). We might have showed those type of gastric carcinogenesis. ConclusionsChief cell in stomach have stem cell activity and potential to develop gastric cancer. Legal entity responsible for the studyThe authors. FundingSingapore Gastric Cancer Consortium. DisclosureAll authors have declared no conflicts of interest.

Efficacy analysis of endoscopic submucosal dissection in gastric adenocarcinoma of fundic gland type: five cases of more than 36 months of follow-up

Background: To explore the feasibility, safety, and effectiveness of endoscopic submucosal dissection (ESD) in the treatment of gastric adenocarcinoma of fundic gland type (GA-FG). Methods: A retrospective analysis was performed for lesion characteristics, treatment, and follow-up of 5 cases of GA-FG patients treated with ESD in our endoscopy center from Jan 2010 to Dec 2018. Results: Among the 5 patients, there were 2 males and 3 females (M:F =2:3). The average age was 59.8±14.4 years old. Four lesions were located at the fundus, while 1 case was located 1.5 cm below the dentate line. Five cases were all flat-uplifted (0–IIa). The average operation time was 28.6±9.0 min. All 5 patients underwent complete resection, and all of them achieved complete resection. There was no recurrence of the 5 cases for 36–49 months of follow-up. Conclusions: ESD can be used as a method for the treatment of GA-FG.

Efficacy analysis of endoscopic submucosal dissection in gastric adenocarcinoma of fundic gland type: five cases of more than 36 months of follow-up.

BackgroundTo explore the feasibility, safety, and effectiveness of endoscopic submucosal dissection (ESD) in the treatment of gastric adenocarcinoma of fundic gland type (GA-FG).MethodsA retrospective analysis was performed for lesion characteristics, treatment, and follow-up of 5 cases of GA-FG patients treated with ESD in our endoscopy center from Jan 2010 to Dec 2018.ResultsAmong the 5 patients, there were 2 males and 3 females (M:F =2:3). The average age was 59.8±14.4 years old. Four lesions were located at the fundus, while 1 case was located 1.5 cm below the dentate line. Five cases were all flat-uplifted (0–IIa). The average operation time was 28.6±9.0 min. All 5 patients underwent complete resection, and all of them achieved complete resection. There was no recurrence of the 5 cases for 36–49 months of follow-up.ConclusionsESD can be used as a method for the treatment of GA-FG.

Oxyntic gland neoplasm of the stomach: expanding the spectrum and proposal of terminology.

Gastric neoplasms exhibiting oxyntic gland differentiation typically are composed of cells with mild cytonuclear atypia differentiating to chief cells and to a lesser extent, parietal cells. Such tumors with atypical features have been reported also and terminology for this entity remains a matter of considerable debate. We analyzed and classified 26 tumors as oxyntic gland neoplasms within mucosa (group A, eight tumors) and with submucosal invasion. The latter was divided further into those with typical histologic features (group B, 14 tumors) and atypical features, including high-grade nuclear or architectural abnormality and presence of atypical cellular differentiation (group C, four tumors). Groups A and B tumors shared similar histologic features displaying either a chief cell predominant pattern characterized by monotonous chief cell proliferation, or a well-differentiated mixed cell pattern showing admixture of chief and parietal cells resembling fundic gland. In addition, group C tumors displayed atypical cellular differentiation, including mucous neck cell and foveolar epithelium. Moderate or even marked cytological atypia was noted in group C, whereas it was usually mild in the other groups except for three group B tumors with focal moderate atypia. More than 1000 μm submucosal invasion and lymphovascular invasions were recognized only in group C. Mutation analyses identified KRAS mutation in one group C tumor as well as GNAS mutation in in one group A and group B tumors. Intramucosal tumors appear to behave biologically benign and should be classified as "oxyntic gland adenoma". Those with submucosal invasion also have low malignant potential; however, a subset will have atypical features associated with aggressive histologic features and should be designated as "adenocarcinoma of fundic gland type". Especially, we suggest "adenocarcinoma of fundic gland mucosa type" for tumors with submucosal invasion exhibiting atypical cellular differentiation, because the feature is likely to be a sign of aggressive phenotype.

A case of multiple early gastric cancers with variant differentiation including gastric adenocarcinoma of fundic gland type

A case of multiple early gastric cancers with variant differentiation including gastric adenocarcinoma of fundic gland type

Gastric adenocarcinoma of fundic gland type arising from heterotopic gastric glands during a 19-year follow-up period

A 73-year-old man with prior history of duodenal ulcer has been undergoing periodic upper gastrointestinal endoscopy since 1999. In 2017, a 25-mm submucosal tumor-like protrusion was detected in the lesser curvature of the upper stomach; histological examination of the lesion revealed gastric adenocarcinoma of fundic gland type. En bloc resection was achieved using endoscopic submucosal dissection. The patient was histopathologically diagnosed with gastric adenocarcinoma of fundic gland type arising from heterotopic gastric glands. Immunohistochemical staining was positive for MUC5AC, MUC6, pepsinogen I, and proton pump but negative for MUC2 and CD10. Moreover, the patient’s Ki-67 labeling index score was extremely low. The presence of MUC5AC indicated that the tumor differentiated to the foveolar epithelium and fundic glands. Gastric adenocarcinoma of fundic gland type that differentiates to several directions has a higher malignant potential than the disease that differentiates to chief cells. A retrospective review of the patient’s previous endoscopic examination revealed that the submucosal tumor-like protrusion existed since 2000; tumor size increased from 8 mm in 2000 to 25 mm in 2017. The present case is rare in that the carcinoma arose from heterotopic gastric glands. Moreover, the 19-year follow-up revealed that the tumor differentiated to the foveolar epithelium, considered as having high-grade malignancy.

Two Cases of Gastric Adenocarcinoma of Fundic Gland Type Diagnosed Incidentally During Endoscopy in a Health Check-up

Two Cases of Gastric Adenocarcinoma of Fundic Gland Type Diagnosed Incidentally During Endoscopy in a Health Check-up

Limitation in Defining Ablation Line by Magnified Endoscopic Imaging for Endoscopic Submucosal Resection of Gastric Adenocarcinoma of Fundic Gland Type as Revealed by 3D Reconstruction Images of Gastric Tissue Specimens.

Limitation in Defining Ablation Line by Magnified Endoscopic Imaging for Endoscopic Submucosal Resection of Gastric Adenocarcinoma of Fundic Gland Type as Revealed by 3D Reconstruction Images of Gastric Tissue Specimens.