Gastric adenocarcinoma of the fundic gland(chief cell-predominant type): A review of endoscopic and clinicopathological features

Gastric adenocarcinoma of the fundic gland(chief cellpredominant type, GA-FG-CCP) is a rare variant of welldifferentiated adenocarcinoma, and has been proposed to be a novel disease entity. GA-FG-CCP originates from the gastric mucosa of the fundic gland region without chronic gastritis or intestinal metaplasia. The majority of GA-FG-CCPs exhibit either a submucosal tumor-like superficial elevated shape or a flat shape on macroscopic examination. Narrow-band imaging with endoscopic magnification may reveal a regular or an irregular microvascular pattern, depending on the degree of tumor exposure to the mucosal surface. Pathological analysis of GA-FG-CCPs is characterized by a high frequency of submucosal invasion, rare occurrences of lymphatic and venous invasion, and low-grade malignancy. Detection of diffuse positivity for pepsinogen-I by immunohistochemistry is specific for GA-FG-CCP. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP. Nearly all GA-FG-CCPs are treated by endoscopic resection due to their small tumor size and low risk of recurrence or metastasis.

Gastric adenocarcinoma of fundic gland type with signet-ring cell carcinoma component: A case report and review of the literature

A depressed lesion was found at a gastric angle of 76-yearold Japanese woman by esophagogastroduodenoscopy. Four years prior, she was diagnosed with a Helicobacter pylori infection but no eradication was performed. The pathological diagnosis of biopsy specimens was signet-ring cell carcinoma. Endoscopic submucosal dissection(ESD) was performed. Histopathological examination of the ESD specimen revealed proliferation of well-differentiated tubular adenocarcinoma mimicking fundic gland cells at the deep layer of the lamina propria mucosae. These tumor cells expressed focally pepsinogen-Ⅰ, diffusely MUC6, and scattered H^+/K^+ ATPase according to immunohistochemistry. Therefore, we diagnosed this tumor as gastric adenocarcinoma of fundic gland type(GA-FG). Adjacent to the GA-FG, proliferation of signet-ring cell carcinoma which diffusely expressed MUC 2 and MUC 5AC was observed. Intestinal metaplasia was focally observed in the surrounding mucosa of the signet-ring cell carcinoma. To the best of our knowledge, this is the first case report of GA-FG with a signet-ring cell carcinoma component. The origin of signet-ring cell carcinoma, i.e., whether it accidentally arose from a non-neoplastic mucosa and coexisted with the GA-FG or dedifferentiated from the GA-FG is unclear at present. We expect the accumulation of similar cases and further analysis to clarify this issue.

Gastric adenocarcinoma of fundic gland type: Five cases treated with endoscopic resection

Recently,a new disease entity termed gastric adenocarcinoma of fundic gland type(GA-FG) was proposed.We treated five cases of GA-FG with endoscopic submucosal dissection.All tumors were small and located in the upper third of the stomach.Four tumors were macroscopically identified as 0-IIa and one was identified as 0-Ⅱb.Narrow-band imaging with magnifying endoscopy showed an irregular microvascular pattern in 2 cases and a regular microvascular pattern in the remainder.All tumors arose from the deep layer of the lamina propria mucosae and showed submucosal invasion.Lymphatic invasion was seen only in one case,while no venous invasion was recognized.All tumors were positive for pepsinogen-Ⅰ and MUC6 by immunohistochemistry.None showed p53 overexpression,and the labeling index of Ki-67 was low in all cases.All cases have been free from recurrence or metastasis.Herein,we discussed the clinicopathological features of GA-FG in comparison with past reports.

Gastric adenocarcinoma of fundic gland type:Endoscopicand clinicopathological features

Gastric adenocarcinoma of fundic gland type(GA-FG) with chief cell differentiation was recently proposed as an extremely rare type of gastric adenocarcinoma. Here, we report 4 cases of GA-FG with chief cell differentiation. Endoscopic features included a submucosal tumor shape or a flat shape, whitish discoloration and dilated vessels on the surface. The tumors were located in the upper or middle third of the stomach. All cases were preoperatively diagnosed as GA-FG by biopsy, and endoscopic submucosal dissection was performed. Resected specimens revealed well-differentiated adenocarcinomas resembling chief cells. Tumor cells were diffusely positive for pepsinogen-Ⅰ, but partially positive for H+/K+-ATPase in scattered locations around the tumor margin. Despite the presence of minimal invasion of the carcinoma into the submucosal layer, which was observed in two cases, neither lymphatic nor venous invasion was detected in any of the cases. Finally, all cases showed less aggressive clinical behavior with low grade malignancy.

Multiple gastric adenocarcinoma of fundic gland type: A case report

BACKGROUND In recent years, there have been reports of a new histological type of gastric cancer, termed gastric adenocarcinoma of the fundic gland (GA-FG). This disease entity presents differentiation towards the fundic gland, especially chief cellpredominant differentiation (GA-FG-CCP). GA-FG-CCP easily invades into the submucosa but rarely shows metastasis. The reports mostly describe primarily single lesions. Herein, we report a case with multiple lesions, and summarize the clinicopathologic characteristics of multiple cases. CASE SUMMARY A 55-year-old woman underwent upper gastrointestinal endoscopy screening. Two whitish lesions on the anterior wall of the gastric corpus and the gastric fundus were detected. The patient had previously received Helicobacter pylori eradication therapy. The mucosa was characterized as grade C-2 atrophic gastritis. We diagnosed the patient with multiple GA-FG (GA-FG-CCP) by hematoxylin and eosin (HE) staining and immunohistochemical staining of the endoscopic biopsy. Upon performing endoscopic submucosal dissection (ESD), one lesion was not found, but the scar from the biopsy was visible;the mucularis mucosa of the biopsy and ESD-resected specimen were intact. The two lesions showed no lymphatic nor venous invasion. The resection performed appeared to be relatively curative. CONCLUSION Cases of multiple GA-FG-CCP are very rare in clinical practice. Most of its clinicopathologic characteristics are similar to those of a single lesion. Our case provides diagnostic and therapeutic information about GA-FG-CCP with multiple lesions.

Signet-ring cell carcinoma arising from a fundic gland polyp in the stomach

Fundic gland polyps(FGPs)are currently the most common type of gastric polyps and are usually benign.However,although rare,gastric adenocarcinoma of FGP has been recently proposed as a new variant of gastric adenocarcinoma.Here we report the first case of a49-year-old woman with focal signet ring cell carcinoma that arose from an FGP of the stomach.The tumor was completely excised by endoscopic snare polypectomy.FGPs should therefore be evaluated for malignant changes although they occur rarely,if the FGP has an erosive or irregular surface.

Two cases of adenocarcinoma occurring in sporadic fundic gland polyps observed by magnifying endoscopy with narrow band imaging

Gastric fundic gland polyps(FGPs) are common nonadenomatous gastric polyps arising from normal fundic mucosa without Helicobacter pylori(H. pylori) infection. Although systemic FGPs associated with familial adenomatous polyposis(FAP) often have dysplasia, there are few reports of dysplasia occurring in sporadic F G P s, e s p e c i a l l y w h e n d e t e c t e d b y m a g n i f y i n g endoscopy with narrow band imaging(ME-NBI). We experienced two cases of adenocarcinoma occurring in sporadic FGPs, and their ME-NBI findings were very useful for differentiating FGP with cancer from nondysplastic FGP. A 68-year-old man and a 63-year-old woman were referred to our institution for medical checkup. H. pylori was negative in both patients. Endoscopic examination revealed a small reddishpolypoid lesion on the anterior wall of the upper gastric body and several FGPs. ME-NBI showed an irregular microvascular architecture composed of closed loop- or open loop-type vascular components, plus an irregular microsurface structure composed of oval-type surface components which was different from that of FGPs. FAP was denied because of the absence of colon polyps and no familial history of FAP. Pathological diagnosis was adenocarcinoma occurring in sporadic FGP.

Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands

Herein, we present a case of gastric adenocarcinoma of fundic gland type(GA-FG) spreading to heterotopic gastric glands(HGG) in the submucosa. A 58-year-old man with epigastric pain was referred to our hospital and underwent an esophagogastroduodenoscopy. A Borrmann type II gastric cancer at the antrum and a 10 mm submucosal tumor-like lesion in the lesser curvature of the upper third of the stomach were detected. Histological examination of the biopsy specimens obtained from the submucosal tumorlike lesion suggested a GA-FG. Therefore, endoscopic submucosal dissection was performed as excisional biopsy, and histopathological examination of the resected specimen confirmed a GA-FG and HGG proximal to the GA-FG. Although the GA-FG invaded the submucosal layer slightly, the submucosal lesion of the GA-FG had a poor stromal reaction and was located just above the HGG in the submucosa. Therefore, wefinally diagnosed the lesion as a GA-FG invading the submucosal layer by spreading to HGG.

Gastric adenocarcinoma of fundic gland type after Helicobacter pylori eradication:A case report

BACKGROUND Gastric adenocarcinoma of fundic gland type (GA-FG) has recently been proposed as a novel histological type of gastric cancer. CASE SUMMARY We report a case of GA-FG in a 77-year-old Chinese woman with epigastric distention who was referred to endoscopy for the management of an incidentally found submucosal tumor-like elevated lesion in the lower part of the gastric body. The tumor occurred after Helicobacter pylori (H. pylori) eradication therapy without long-term use of proton pump inhibitors. Complete and curable removal of the tumor was performed by endoscopic submucosal dissection. Histopathological findings showed numerous cells with basophilic cytoplasm and mildly atypical nuclei-like chief cells of the fundic gland. The tumor was observed to have the so-called “endless glands” pattern of the well-differentiated mixed phenotype. A safe resection margin without lymphatic and venous invasion was observed. As the tumor occurred after H. pylori eradication therapy, it is unknown whether there was a relationship with H. pylori eradication. The patient will be followed up by periodic gastroscopic observation. CONCLUSION In conclusion, we report a case of GA-FG after H. pylori eradication therapy without long-term proton pump inhibitors use. Further analysis of similar cases will reveal the clinical behavior of GA-FG.

Sporadic fundic gland polyps with dysplasia or carcinoma:Clinical and endoscopic characteristics

Fundic gland polyps(FGPs)are the most common gastric polyps and have been regarded as benign lesions with little malignant potential,except in the setting of familial adenomatous polyposis.However,in recent years,the prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors(PPIs).To date,several cases of FGPs with dysplasia or carcinoma(FGPD/CAs)have been reported.In this review,we evaluated the clinical and endoscopic characteristics of sporadic FGPD/CAs.Majority of the patients with sporadic FGPD/CAs were middle-aged women receiving PPI therapy and without Helicobacter pylori(H.pylori)infection.Majority of the sporadic FGPD/CAs occurred in the body of the stomach and were sessile and small with a mean size of 5.4 mm.The sporadic FGPs with carcinoma showed redness,irregular surface structure,depression,or erosion during white light observation and irregular microvessels on the lesion surface during magnifying narrow-band imaging.In addition,sporadic FGPs,even with dysplasia,are likely to progress to cancer slowly.Therefore,frequent endoscopy is not required for patients with sporadic FGPs.However,histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed,regardless of their size.In the future,the prevalence of FGPs is expected to further increase along with the widespread and frequent use of PPIs and decreasing infection rate of H.pylori.Currently,it is unclear whether FGPD/CAs will also increase in the same way as FGPs.However,the trends of these lesions warrant further attention in the future.

Enhanced production of leptin in gastric fundic mucosa with Helicobacter pyloriinfection

AIM: To determine the concentrations of leptin in plasma and gastric fundic mucosa in humans, with reference to Helicobacter pylori (H pylori) infection, and their association with gaslric mucosal levels of interleukin (IL)-1β, IL-6 and IL-8.METHODS: Plasma leptin concentrations were determined in 135 outpatients with non-ulcer dyspepsia, consisting of95 H pylori-infected and 40 uninfected subjects, and 13 patients before and after cure of the infection with anti-H pylori regimen. Using biopsy samples that were endoscopically obtained from the middle corpus along the greater curvature,gastric leptin contents were measured by radioimmunoassay and the mucosal concentrations of IL-1β, IL-6 and IL-8 were measured by enzyme linked immunosorbent assay. We also analysed the expression of leptin in the fundic mucosa by reverse transcriptase-polymerase chain reaction (RT-PCR)and immunohistochemistry.RESULTS: The mucosal levels of leptin in the fundic mucosa of H pylori-infected patients were significantly higher than those of uninfected patients. The amount of gastric leptin correlated positively with the mucosal levels of IL-1β and IL-6, but not IL-8. Circulating leptin correlated with body mass index, but not with H pylori status, and there was no change in plasma leptin levels following cure of the infection.Leptin immunoreactive cells were noted in the lower half of the fundic glands, and its expression of messenger ribonucleic acid in the oxyntic mucosa was detected by RT-PCR.CONCLUSION: Leptin production is enhanced in H pyloriinfected gastric mucosa. Gastric leptin may' be involved in immune and inflammatory response during H pylori infection,through interaction with proinfiammatory cytokines.

Proton pump inhibitors and an emerging epidemic of gastric fundic gland polyposis

Fundic gland polyps are now commonly recognized during endoscopy. These polyps are benign, often multiple and usually detected in the gastric body and fundus. In the past, these polyps were sometimes associated with familial adenomatous polyposis. In recent years, it has become evident that increasing numbers of these polyps are being detected during endoscopic studies, particularly in patients treated with proton pump inhibitors for prolonged periods. In some, dysplastic changes in these polyps have also been reported. Recent studies have suggested that there may be no increase in risk of colon cancer with long-term proton pump inhibitor therapy. While temporarily reassuring, ongoing vigilance, particularly in those genetically predisposed to colon cancer, is still warranted.

Giant sporadic fundic gland polyp:Endoscopic and endosonographic features and management

Fundic gland polyps are the most common gastric polyps. They are usually small in size, sporadic and asymptomatic. We present a case of giant fundic gland polyp. Our case is particular because of the clinica presentation, the endoscopic and endosonographic documented findings, and the treatment otpions followed.

胃泌酸腺肿瘤49例临床病理学分析

目的:分析胃泌酸腺肿瘤的临床病理学特征。方法:选取2016年1月—2020年12月于山东大学第二医院确诊的49例胃泌酸腺肿瘤包括泌酸腺腺瘤(OGA)和胃底腺型腺癌(GA-FG)为研究对象,回顾性分析其临床资料、内镜表现、组织学特征、免疫表型并进行随访。结果:胃泌酸腺肿瘤的患者年龄19~83岁,平均(57.3±2.4)岁,男女比例为24∶25。病变主要位于胃体(27/49)和胃底(15/49)。内镜下有4种表现:扁平隆起型、息肉样、扁平型和凹陷型。部分病变可见扩张的树枝状血管。48例为单发,病变最大径平均为(3.9±0.5)mm(1.0~7.0 mm)。7例表现为黏膜下浸润,浸润深度均小于500μm。该肿瘤由密集的腺体吻合呈条索状,镜下呈不规则分支状、迷路状。该类肿瘤细胞分化好,形态类似于泌酸腺细胞,以主细胞为主,细胞核轻度增大,有轻微异型性,核分裂像少见。免疫标志物MUC6(100%)和Pepsinogen-Ⅰ(83%)呈弥漫性阳性,H+/K+-ATPase不同程度阳性(58%)。结论:泌酸腺肿瘤是一种新的胃肿瘤组织学类型,具有独特的临床病理特征,该类肿瘤发病率较低,预后良好,但仍需长期随访。

胃底腺黏膜型腺癌4例临床病理特征

目的观察胃底腺黏膜型腺癌(gastric adenocarcinoma of fundic-gland mucosa type,GA-FGM)的临床病理学特征。方法回顾性分析4例GA-FGM的临床病理资料,采用免疫组化EnVision法检测黏蛋白(MUC5AC、MUC6)表达,并复习相关文献。结果肿瘤向胃小凹上皮和胃底腺两种方向分化。胃小凹上皮分化部分由低度异型的高柱状肿瘤性上皮构成,可呈乳头状、绒毛状或管状形态,免疫组化标记MUC5AC阳性;胃底腺分化成分表现为向颈黏液细胞、主细胞和壁细胞分化,免疫组化标记MUC6阳性。结论GA-FGM具有独特的形态学特征,活检诊断困难,与胃底腺型腺癌形态学有重叠又有不同,需加强认识,免疫组化在鉴别诊断中起重要作用。

Sporadic fundic gland polyps are not associated with proton pump inhibitors therapy but negatively correlate with Helicobacter pylori infection in China

Background Sporadic fundic gland polyps （FGPs） are common gastric polyps.Some studies reported that FGPs dramatically increased due to proton pump inhibitors （PPIs） use and a decreased prevalence of Helicobacter pylori （H.pylon） infection in Western countries.However,data are still controversial.This study aimed to identify the relationships between these two factors and FGPs in China.Methods Consecutive patients with FGPs detected were retrospectively analyzed.Data including patients＇ age,sex,symptoms,H.pylori infection,history of PPIs use,and the polyps were documented.Each patient was compared with two randomly selected age-and sex-matched controls with similar symptoms in the same period.Results During the period from March 2011 to March 2012,a total of 328 patients were diagnosed as FGPs in 23 047 patients who underwent routine esophagogastroduodenoscopy and 656 patients without FGPs as controls.The mean age was （55.12±12.61） years,and 75.91％ were women.The prevalence of H.pylori in patients with FGPs was significantly lower than in those without FGPs （22.30％ （64/287） vs.42.26％ （224/530）,P ＜0.001,OR 0.392,95％ Cl 0.283-0.544）.Overall,a total of 54 patients with FGPs （54/328,16.46％） and 136 patients without FGPs （136/656,20.73％） received PPIs therapy （P=0.110）.According to the different duration of PPIs use,no significant differences of PPIs use were found between the cases and controls among all subgroups.Moreover,the PPIs use was also similar,regardless of age,sex,H.pylori infection,and the number of polyps.Conclusion Sporadic FGPs may not be induced by PPIs therapy but negatively correlate with H.pylori infection in China,which is not the same with the data in Western countries.

Typical endoscopic appearance accurately predicts sporadic fundic gland polyps： a retrospective study of 47 771 endoscopies

Sporadic fundic gland polyps （FGPs） account for 0.8%- 1.9% of all gastric polyps and are observed in patients undergoing esophagogastroduodenoscopy （EGD） in whom they account for more than 50% of all gastric polyps. The prevalence is increasing in recent years possibly due to decreased Helicobacter pylori （1t. pylori） infection rate and long-term proton pump inhibitor use. Generally, sporadic FGPs are assumed to be benign polyps with no risk of malignant transformation. We evaluated the feasibility of predicting sporadic FGPs based on typical endoscopic appearance in a large database of 47 771 endoscopies.

胃底腺胃腺癌一例

胃底腺胃腺癌(GA-FG)是一种起源于胃底腺黏膜罕见的胃癌亚型,通常分化良好,少见淋巴管和血管浸润,99%以上的肿瘤细胞向主细胞分化。内镜下黏膜剥离术(ESD)是目前治疗的最佳方法,预后良好,罕见复发及转移。

胃底腺息肉与结直肠息肉相关性研究分析

目的分析胃底腺息肉和结直肠息肉之间的关联性。方法选取2021年5月—2022年12月在南京中医药大学附属中西医结合医院住院经胃镜及病理确诊为胃底腺息肉,同期行电子结肠镜检查(两项检查间隔不超过半年)的100例患者为病例组,随机选取同期行胃肠镜检查且未发现胃底腺息肉的200例患者为对照组。分析其性别分布、年龄分布、高血脂人数、胃底腺息肉病变部位、数量、直径、结直肠息肉种类、数目、直径、病变部位。结果病例组结直肠息肉检出率高于对照组,差异有统计学意义(P<0.05)。其中年龄≥45岁胃底腺息肉患者结直肠息肉检出率更高,差异有统计学意义(P<0.05),合并高血脂的胃底腺息肉患者更易患结直肠息肉,差异有统计学意义(P<0.05)。结论较非胃底腺息肉患者,胃底腺息肉患者患结直肠息肉的可能性更高,年龄≥45岁、高血脂是胃底腺息肉患者合并结直肠息肉的危险因素。

探头式共聚焦激光显微内镜对胃底腺息肉的诊断价值

目的探讨探头式共聚焦激光显微内镜(probe-based confocal laser endomicroscopy,pCLE)在胃底腺息肉诊断中的价值。方法纳入2023年6-12月于陆军军医大学第一附属医院消化内科内镜中心行普通白光内镜(white light image,WLI)提示胃息肉患者63例,收集患者临床资料、白光内镜图像、窄带成像内镜(narrow band imaging,NBI)图像、pCLE内镜图像以及术后组织病理,统计验证胃底腺息肉在pCLE内镜下特点,分别计算不同内镜诊断的灵敏度、特异性、准确度、一致性。结果胃底腺息肉在pCLE内镜下主要表现为胃小凹开口拉长,“手牵手样”胃小凹开口,小凹开口周围血管规则,无荧光素渗出。WLI的灵敏度、特异度、准确度、一致性分别为:72.73%、75.00%、73.13%、0.343(胃底腺息肉),81.82%、71.43%、71.64%、0.354(增生性息肉);NBI的灵敏度、特异度、准确度、一致性分别为87.27%、83.33%、86.57%、0.673(胃底腺息肉);81.82%、85.71%、85.07%、0.554(增生性息肉);pCLE的灵敏度、特异度、准确度、一致性分别为92.73%、91.67%、92.53%、0.769(胃底腺息肉),90.91%、94.64%、94.03%、0.797(增生性息肉)。pCLE的灵敏度、特异度等均优于WLI和NBI,与病理诊断的一致性较好。结论pCLE可用于胃底腺息肉的诊断。