Gastritis Cystica Polyposa Research Articles

A178 GASTROINTESTINAL STRICTURES IN A PEDIATRIC PATIENT WITH SATOYOSHI SYNDROME

Abstract Background Satoyoshi syndrome (SS) is a rare, progressive, multisystem disease including muscle spasms, alopecia, skeletal deformities, and diarrhea, with suspected autoimmune etiology. Treatment includes corticosteroids, immunoglobulin therapy, or immunosuppression. Reported endoscopic findings include loss of intestinal folds and nodularity in the stomach and the intestine, with histology showing gastritis cystica polyposa and lymphoplasmacytic infiltrate, as well as fibrosis noted on autopsy reports. To date, no cases of intestinal stricture have been described in SS. Aims To describe an original case of intestinal strictures in SS. Methods Case report and literature review. Results We present a case of a 10-year-old girl with chronic diarrhea and intermittent hematochezia, postprandial abdominal pain, intermittent non-bilious emesis, stunted growth, and weight loss, with acquired alopecia and severe muscle cramps. Examination showed a non-dysmorphic, small child with alopecia totalis and a distended, tender abdomen. Investigations demonstrated an unremarkable endocrine work-up, mild hypoalbuminemia, microcytic anemia, and anti-transglutaminase serology at 3-4x ULN with no improvement on the gluten-free diet. Endoscopy identified a duodenal stricture with a very distended stomach and duodenal bulb, mucosal nodularity and bridging creating a web-like appearance, and edema and friability of the left-sided colon. MR enterography confirmed an isolated duodenal stricture. Pathology displayed patchy fibrosis with crypt/glandular dilatation in the antrum, duodenum, and rectum. Skeletal imaging detected physeal widening and sclerosis with mild slipping of the epiphyses. Auto-immune markers included positive ENA profile for anti-Sm, anti-Sm/RNP, and anti-RNP-A. The patient was treated with corticosteroids in addition to a series of endoscopic dilatations for duodenal stricture with symptomatic benefit, with addition of upadacitinib for alopecia management. Follow-up revealed intermittent worsening of symptoms with steroid taper, necessitating further duodenal dilatations, and evidence of a new anal stricture. The patient remains on corticosteroid therapy with ongoing surveillance. Conclusions This case identifies the first report of intestinal strictures in SS, which may suggest that in addition to suspected autoimmune pathogenesis, disorders of fibrogenesis may need to be considered. Funding Agencies None

Large Gastritis Cystica Polyposa Treated with EMR Polypectomy in Patient without History of Gastric Surgery

Large Gastritis Cystica Polyposa Treated with EMR Polypectomy in Patient without History of Gastric Surgery

Gastritis cystica polyposa in an unoperated stomach, a case report

Gastritis cystica polyposis (GCP) is a rare benign hyperplastic polypoid neoplasm that usually occurs on the gastric side of anastomoses in patients who have previously undergone gastroenterostomy surgery. Only few cases of GCP have been reported in a previously unoperated stomach. Here we present a 73-year-old female who on investigation for altered bowel habits was found to have a gastric polyp diagnosed as GCP. Both endoscopic and radiological findings are non-specific, and diagnosis depends on histopathological evaluation of the lesion. Histologically the lesion showed a hyperplastic polyp with cystically dilated foveolar and glandular epithelium extending into the submucosa surrounded by disorganised bundles of smooth muscle and without any evidence of cytologic atypia, typical of GCP. Although benign, an associated with gastric carcinoma has been described.

A surgically treated case of severe upper gastrointestinal hemorrhage with gastritis cystica polyposa

BackgroundGastritis cystica polyposa (GCP) is a recently recognized entity histologically characterized by hyperplasia and cystic dilatation of the gastric glands spreading through the submucosal layer. Its symptoms include those affecting the upper gastrointestinal tract, such as upper abdominal pain, nausea, and anorexia, although some patients might be asymptomatic. GCP rarely causes severe hemorrhage. Recently, we encountered a GCP case that exhibited severe hemorrhage.Case presentationA 53 year-old man visited the emergency department complaining of hematemesis. He underwent distal gastrectomy and Billroth II reconstruction for duodenal ulcers 32 years ago. Upper gastrointestinal endoscopy detected bleeding from the reddened mucosa at the anastomosis; thus, tentative endoscopic hemostasis was conducted. Despite medical treatment with transfusion, melena with significant hemodynamic impairment persisted. He was treated again with endoscopic hemostasis and interventional radiology (IVR) but remained unresponsive to these procedures. He eventually underwent partial resection of the anastomosis site with Roux-en-Y reconstruction and finally achieved excellent postoperative recovery. Histopathological examination of the resected specimen suggested a GCP bleeding.ConclusionsGCP can indeed cause severe hemorrhage. Hemorrhage caused by GCP may not respond to endoscopic hemostasis or IVR; therefore, surgical treatment should be decided without delay.

A Case of Gastritis Cystica Polyposa with Early Multiple Gastric Cancer in a Previously Non-operated Stomach

A Case of Gastritis Cystica Polyposa with Early Multiple Gastric Cancer in a Previously Non-operated Stomach

Gastritis Cystica Polyposa Presenting as Multiple Polypoid Lesions in an Unoperated Stomach: Complexity in the Management of a Rare Case

Gastritis Cystica Polyposa Presenting as Multiple Polypoid Lesions in an Unoperated Stomach: Complexity in the Management of a Rare Case

Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection

Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection

Epstein-Barr virus-associated gastric carcinoma in the remnant stomach: de novo and metachronous gastric remnant carcinoma

The remnant stomach corresponds to the gastric cardia, but is exposed to a completely different environment. The present study was performed to investigate the role of Epstein-Barr virus (EBV) infection in patients with gastric remnant carcinoma (GRC). Clinicopathological features, gastritis, and infection by EBV were investigated in patients with two types of GRC: GRC occurring at an interval of 10 years or longer between operations (de novo GRC group) and GRC occurring within 10 years after the initial operation for gastric carcinoma (metachronous GRC group). EBV involvement in the de novo GRC group (23%) was not significantly different from that in the cardia of non-remnant carcinomas (controls; 18%). EBV involvement showed greater correlations in male patients (18/63; 28%), and in those with gastritis cystica polyposa (GCP; 13/41; 31%), and those with an interval of 20 years or longer (15/50; 30%) than with the other parameters. Multivariate analysis showed a significant correlation between GCP and EBV infection. Histologically, hyperplasia or mild atrophy, and mild lymphocytic infiltration were observed in 56% and 67% of non-neoplastic mucosa of EBV-associated GRC, respectively. In the metachronous GRC group, EBV-encoded mRNA in situ hybridization (EBER-ISH) of 27 pairs of primary gastric carcinomas (GCs) and metachronous GRCs indicated that only six EBV (+) metachronous GRCs were derived from EBV (+) GC. Epstein-Barr virus infection, together with long-standing inflammation, which causes GCP, may facilitate the development of de novo GRC. Close follow-up of patients treated with distal gastrectomy for EBV-associated GC is necessary to detect metachronous GRC.

A case of CA19-9-producing adenocarcinoma of the remnant stomach resembling gastritis cystica polyposa

Gastritis cystica polyposa (GCP) is a well-known precancerous lesion of the remnant stomach. We report a case of carbohydrate antigen (CA) 19–9-producing well-differentiated adenocarcinoma of the remnant stomach that resembled GCP. The patient was a 66-year-old Japanese man who had undergone subtotal gastrectomy 20 years previously. The tumor developed in the remnant stomach at the anastomotic line. Histologically, the lesion completely encircled the gastroenterostomy stoma. There was florid growth of glands with cystic dilatation and minimal atypia extending through the thickened muscularis propria into the subserosa. Small foci of less well-differentiated adenocarcinoma were also detected, including irregular glands or small clusters of mucus-producing cells with moderate atypia. Immunostaining revealed that numerous tumor cells were positive for carcinoembryonic antigen and CA19-9, whereas only a few cells were positive for p53. The macroscopic, histopathological and immunohistochemical findings indicated a diagnosis of CA19-9-producing well-differentiated adenocarcinoma of the remnant stomach. To avoid underdiagnosis, careful attention should be paid to the above-mentioned morphological features and immunohistochemical findings, in addition to the endoscopic findings.

Gastritis Cystica Polyposa Concomitant with Gastric Inflammatory Fibroid Polyp Occurring in an Unoperated Stomach

The endoscopic examination of a 61-year-old male patient revealed a protruding lesion in the greater curvature of the lower third area of the stomach. The lesion, 17 mm in size, was resected completely with endoscopic submucosal dissection using an insulated-tip diathermic knife (IT-ESD). Histological examination of the protruding lesion revealed proliferation of fibroblasts and infiltration of inflammatory cells in the mucosa and submucosa, and it was diagnosed as an inflammatory fibroid polyp (IFP). Gastritis cystica polyposa (GCP) was presented adjacent to the IFP. This may be the first report of GCP concomitant with gastric IFP occurring in an unoperated stomach.

Duodenogastric reflux and gastric stump carcinoma.

Gastric stump carcinoma after gastric surgery for benign disease is now widely recognized as a distinct clinical entity. The stump carcinoma was often found to be localized to the anastomosis, known to be the site with severe duodenogastric reflux. For this reason, duodenogastric reflux, including the reflux of bile and pancreatic juice, after a Billroth II procedure for benign disease is frequently discussed as an important factor related to the development of stump carcinoma. Many experiments have implicated bile acids, the main component of the duodenal juice, in gastric carcinogenesis. In particular, rat models without the use of the carcinogen, N-methyl-N'-nitro-N-nitrosoguanidine (MNNG), showed adenocarcinoma in the remnant stomach that was related to the severity of duodenogastric reflux. However, human data are, inevitably, much less consistent. Whether the incidence of stump carcinoma is higher than that of gastric carcinoma in general is still controversial. Concerning the histogenesis of stump carcinoma after benign disease, a relationship between gastritis cystica polyposa (GCP) and gastric type adenocarcinoma has been suggested. Recently, the population at risk of gastric stump carcinoma for benign disease has been diminishing significantly, and the incidence of gastric stump carcinoma after surgery for malignant disease has been increasing. The influence of duodenogastric reflux in the gastric remnant after malignant disease may differ from its influence in the gastric remnant after benign disease. Further clinical study is needed to elucidate the pathogenetic factors involved in gastric stump carcinoma.

The influence of pylorus-preserving partial gastrectomy on carcinogenesis of residual gastric mucosa in the rat.

The aim of this study is to investigate a pylorus- and vagus-nerve-preserving partial gastrectomy to discover any correlation to a reduced carcinoma occurrence from residual gastric mucosa. Wistar rats underwent a distal partial gastrectomy (Group D), a pylorus-preserving partial gastrectomy (Group P), or a simple laparotomy (as a control) (Group C) while some also underwent an additional truncal vagotomy (Groups DV, PV, and CV). Continuous per oral administration of N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) was given every day for 8 weeks before operation. At 3, 6, and 12 months after surgery, the animals in each group were administered an intraperitoneal injection of bromodeoxyuridine (BrdU). At 1 h after injection, the animal was killed, and the residual stomach removed. The histopathological findings showed no intestinal metaplasia and no gastric cancer in any group. No abnormality in the gastric mucosa was found in either Group C or Group CV. However, anastomotic ulcers, cystic glands, and submucosal gland formation were found significantly more in Groups P and in PV than in either Groups D or DV (each P < 0.05). Atypical glands were found in only one rat in each of Groups D and DV, and gastritis cystica polyposa (GCP) was found in only one rat in Group DV. All of these findings occurred in the fundic gland mucosa on the oral side of the anastomosis. The BrdU labeling index in this fundic gland mucosa was significantly higher in Groups D and DV than that in Groups C and CV, at 3, 6, and 12 months postoperatively (P < 0.05). The pH of the gastric juice was higher in all those groups that underwent vagotomy, with a significant difference only between Groups DV and C (P < 0.05). The concentration of bile acids contained in the gastric juice (microM/l) was significantly lower in Groups P and PV than that in Groups D or DV (each P < 0.05). The preservation of the pylorus was considered to be a useful surgical method to prevent the retrograde reflux of the duodenal juice into the residual stomach, and also reduced the proliferative activity of the residual gastric mucosa on the oral side of the anastomosis.

Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach

Gastritis cystica polyposa (GCP), characterized by polypoid hyperplasia of the gastric mucosa, is an uncommon lesion that develops in patients who have undergone gastroenterostomy with or without gastric resection.1,2 Endoscopically and radiologically GCP appears as a polypoid mass that is almost always on the gastric side of the anastomosis. This lesion is rarely found in an unoperated stomach.1,3,4 Because it is difficult to differentiate GCP from cancer both radiologically and endoscopically, surgery is required in most cases for diagnosis.

Gastritis cystica polyposa associated with a gastric stump carcinoma, with special reference to cell kinetics and p53 gene aberrations.

We report a case of gastritis cystica polyposa (GCP) that developed in association with a small stump carcinoma. The patient had had distal gastrectomy for peptic ulcer 33 years prior to the present illness. Total gastrectomy was carried out for the stump carcinoma of the remnant stomach, followed by Roux-en-Y anastomosis. Histological examination revealed that the cancer was associated with a GCP lesion in its neighborhood. The resected stomach was subjected to a cell kinetics study and p53 gene analysis, as GCPs are thought to have a high potential for carcinogenesis. The GCP mucosae, as well cancer tissues and remnant mucosae obtained from the same specimens, were investigated and compared. We found that cell kinetics, as measured by a Ki-67 labeling index count, was more accelerated in the GCP than in the remnant mucosa, and that p53 gene aberrations, including both mutations and deletions, took place in the GCP lesion. As the p53 gene is considered to be recessive, in principle, its tumor suppressive activity is lost only when gene aberration, either mutation or deletion, occurs concurrently or successively in both alleles. It was of interest to us that a benign lesion such as GCP had, in this instance, already developed both gene aberrations, strongly suggesting a precancerous nature for this disease.

4541 Clinical significance of gastritis cystica polyposa and role of endoscopic ultrasonography.

Background:Gastritis cystica polyposa(GCP) is one of multiple cystic lesion in mucosa(superficialis) and/or submucosal layer(profunda) of stomach. This lesion has been regarded as a benign lesion. However, some authors have reported that gastric cancer and adenoma is arising from GCP, and gastric cancer associated with gastric cystic lesion has also been described. Endoscopic ultrasonography(EUS) is the best diagnostic tool to evaluate small gastric cystic lesion, and it can give exclusive information for gastric tumor lesions associated with gastric submucosal cystic lesion at preoperative state. The aim of this study was to evaluated the typical EUS findings of GCP, the efficacy of EUS as diagnostic tool in GCP and its related tumor lesions. Patient and method:From Jan 1995 to November 1999, we have tried 1350 cases of endoscopy and EUS to differentiate gastric protruding or elevated lesion, 9 cases of GCP was confirmed by endoscopic resection or operation. We analysis clinical features and diagnosis in gastrofiberoscopy and EUS, compare to histologic diagnosis. Results: Clinical symptoms of GCP are abdominal discomfort or indigestion in all GCP patients. Operative history of subtotal gastrectomy was noted in only 3 cases of GCP. Initial endoscopic diagnosis to GCP was incomplete in all cases. Endoscopic findings of GCP are various; 3 gastric polyp, 2 SMT, 2 flat elevated lesion, 1 hypertrophic gastritis, and 1 small polyp coexist with gastric cancer. We could diagnosed GCP in 8 patients through EUS(sensitivity 88.9%, positive predictable rate is 100%). EUS findings is characterized by 14.1mm(9-26) of mean size, multiple variable sized anechoic lesion with intervening hyperechoic structure(8 cases), irregular margin(7), musoca and submucosal thickening(6), and submucosal invasion(5 GCP profunda). In histologic findings, 6 GCP were associated with underlying gastritis only, but two gastric tubular adenomas were located in mucosa above cystic dilatation of gastric gland. One small GCP lesion was noted in other site of upper body in patient with early gatric cancer. Conclusions:EUS is an effective diagnostic tool to evaluate and differentiate GCP from the protruding and elevated gastric lesion, and an important role to decide method of management of GCP. EUS is monopolistic diagnostic procedure to evaluate GCP associated with gastric tumor lesions before resection, and more clinical usefulness of EUS is expected to lighten pathogenetic relationship in these two disease entities in future.

A case of gastritis cystica polyposa showing a characteristic endoscopic ultrasonogram

Littler reported on the torose polypoid lesion observed at the site of gastroenterostomy long after gastrectomy and called it gastritis cystica polyposa (GCP). Since then, much attention has been paid to hypertrophic lesions at the sites of gastroenterostomy, and many reports on GCP have been published. This lesion often develops in patients who had gastroenteroanastomosis. It was observed by the authors that a submucosal tumor developed at the cardiac part of the stomach in a patient who had no history of gastrectomy. Very few cases of GCP were observed in unoperated stomachs. The tumor was excised by endoscopic mucosal resection and diagnosed histopathologically as GCP. Endoscopic ultrasonography before the operation revealed the presence of a spongy body filled with anechoic areas of various sizes under the mucosa of the tumor. This finding is characteristic of this disorder and is detailed here with a discussion on related papers.

A CASE OF STOMAL CARCINOMA OCCURRED 48 YEARS AFTER GASTROJEJUNOSTOMY FOR PYLORIC STENOSIS

A case of stomal carcinoma occurred 48 years after gastrojejunostomy for benign pyloric stenosis is reported. The case involved a 72year-old man who underwent a gastrojejunostomy in the upper body on the greater curvature for benign pyloric stenosis in 1945. In 1985, a stomal ulcer was detected by endoscopic examination, and thereafter he received the endoscopic examination every year. In 1993, histological study of biopsy specimens from the stomal ulcer showed moderately differentiated adenocarcinoma, and total gastrectomy and resection of the stoma including the jejunum were performed on March 22, 1994. Resected specimen revealed another ulcer lesion besides the ulcer lesion shown with endoscopic study. Histological examination of this lesion confirmed signet ring cell carcinoma. Moreover, microscopic finding revealed the features of gastritis cystica polyposa under the cancer lesion in the submucosal region. A total of 33 cases of gastric cancer following gastrojejunostomy without gastrectomy have been reported in Japan, indicating a correlation between regurgitation of bile juice and carcinogenesis.

特徴的な超音波内視鏡像を呈したgastritis cystica polyposaの1例

The patient was a 54-year-old male who had undergone distant partial gastrectomy with reconstruction by the Billroth II procedure 10 years earlier. Endoscopic examination of the upper digestive tract performed due to discomfort during swallowing showed a red tumorous lesion with a smooth surface on the entire circumference of the anastomosis site. Biopsy specimen revealed cystic dilatation and hyperplasia of the glands without atypia. Based on these findings, a diagnosis of gastritis cystica polyposa was made. Endoscopic ultrasonography showed high echoic tumor image in the submucosal layer and an aechoic-low echo multiple small cystic image within, which was covered with nearly normal first and second layers. Compared with histological image, these findings of endoscopic ultrasonography appeared to be specific to gastritis cystica polyposa.

Pathogenesis of adenocarcinoma induced by gastrojejunostomy in Wistar rats: role of duodenogastric reflux.

The pathogenetic effect of duodenogastric reflux of the development of gastric stump carcinoma was studied experimentally. In this animal model, 95 male Wistar rats were subjected to a specially designed gastrojejunostomy to divert the duodenal contents into the resected stomach through the afferent and efferent loop. The rats were fed normally without any carcinogen administration. The incidence of adenocarcinomas around the anastomosis of afferent loop was 0% at 10 weeks, 18.8% at 20 weeks and 34.4% at 40 weeks, so the incidence was apt to rise in parallel with passing of the weeks. At 40 weeks, the rats had a significantly higher incidence of adenocarcinoma in the gastric mucosa around the afferent loop than around the efferent loop (P < 0.05). Of particular interest is that invasive growth of the cancerous tissue into the liver was observed in one animal. Polypoid lesions called 'atypical hyperplasia' in the present study were similar to gastritis cystica polyposa of humans. The development of adenocarcinoma was found to be intimately connected with atypical hyperplasia, which might be promoted by repeated destruction and regeneration by duodenogastric reflux. These results suggest that the direct contact of the duodenal juice with the gastric mucosa induces carcinoma in the anastomotic lesion. From the clinical perspective, our findings suggest that a surgical technique that minimizes the duodenogastric reflux should be chosen.

Gastritis cystica profunda presenting as giant gastric mucosal folds: The role of endoscopic ultrasonography and mucosectomy in the diagnostic work-up

Multiple small cysts in the mucosa and submucosa of the stomach have been rarely encountered. Various terms for these lesions have been proposed, such as gastritis cystica profunda,1 diffuse submucosal cysts of the stomach,2 submucosal heterotopic gastric glands,3 gastritis cystica polyposa,4 and diffuse heterotopic cystic malformation of the stomach.5 These lesions have been found not only at the site of a gastroenterostomy but also in the stomachs of patients without any previous surgery.2,3,6 The diagnostic approach for this disorder depends on the condition of the resected stomach.