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.

Novel classification of gastric polyps:The good,the bad and the ugly

Gastric polyps(GPs)are increasingly common.On upper endoscopy,they should be examined with white light and occasionally chromoendoscopy,and their morphology classified according to the Paris classification.Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection.Histological examination is necessary for an accurate diagnosis.While most polyps are non-neoplastic and do not require treatment,some carry a risk of malignancy or are already malignant.Therefore,understanding the diagnosis,classification,and management of GPs is crucial for patient prognostication.Our new classification categorizes GPs into"good","bad",and"ugly"based on their likelihood of becoming malignant.We aim to provide descriptions of the endoscopic appearance,pathology,treatment,and follow-up for different GPs,as well as clinical management flowcharts.

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.

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.

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.

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 clinical presentation, the endoscopic and endosonographic documented findings, and the treatment otpions followed.

Pepsinogen C Gene Expression in Epithelial Cells of Rat Stomach During Development

Pepsinogens are zymogens of pepsins,aspecific proteases working as digestive enzymes in vertebrate stomach,of which biological and molecular properties have been extensively studied.Several exhaustive studies have been performed in the pepsinogen producing cells in developing rat stomachs,but little is known about the expression of pepsinogen gene in these cells.In this study,the ontogeny of pepsinogen producing cells in rat fundic glands was studied by in situ hybridization using a digoxigenin-labeled RNA probe.The rat gastric epithelium was stratified but was morphologically undifferentiated at the stage of 18.5 days of gestation.The pepsinogen mRNA was expressed both in chief cells and mucous neck cells in adult rats,which was first detected by in situ hybridization in the stomach of the rats at 3.5 days after birth.The development of pepsinogen producing cells could be classified into four stages:(1) 18.5 days of gestation to 0.5 day after birth;(2) 3.5 days to 2 weeks after birth;(3) 3～4 weeks after birth;(4) 8 weeks after birth.Pepsinogen expression is strictly limited to these cells,the distribution of which shown a developmental stage-specific manner.We concluded the pepsinogen C could offer excellent molecular markers of differentiation during stomach epithelial cellulur development.

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.