A case of gastric adenocarcinoma considered to originate from a sporadic fundic gland polyp in a Helicobacter pylori -un
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CASE REPORT
A case of gastric adenocarcinoma considered to originate from a sporadic fundic gland polyp in a Helicobacter pylori‑uninfected stomach Yoshitaka Nawata1 · Shin Ichihara2 · Dai Hirasawa1 · Ippei Tanaka1 · Shuuhei Unno1 · Kimihiro Igarashi1 · Tomoki Matsuda1 Received: 19 March 2020 / Accepted: 19 May 2020 © Japanese Society of Gastroenterology 2020
Abstract We encountered a rare case of gastric adenocarcinoma considered to arise from a sporadic fundic gland polyp (FGP). A woman in her 70 s, who had been prescribed a proton pump inhibitor for 5 years, was referred to our institution for further investigation and treatment of a gastric lesion. White light endoscopy showed numerous isochromatic FGPs in the greater curvature of the gastric body and a 15-mm reddish polypoid lesion with uneven surface characteristics. Magnifying endoscopy with narrow band imaging revealed an irregular granular microsurface structure with irregular microvessels, which is suggestive of cancer. The absence of atrophic changes in the entire gastric mucosa was confirmed endoscopically and histologically, and multiple Helicobacter pylori (HP) tests were negative. An en bloc resection was performed by polypectomy. The specimen showed adenocarcinoma that was thought to arise from an FGP. The lesion consisted of cystically dilated fundic glands in the basal part and neoplastic cells with nuclear atypia and high nuclear–cytoplasmic ratio in the foveolar part; on the basis of these findings, noninvasive adenocarcinoma was diagnosed. Although both adenocarcinoma in an HP-uninfected stomach and epithelial high-grade dysplasia in a sporadic FGP are extremely rare, this possibility should be considered when performing esophagogastroduodenoscopy. Keywords Fundic gland polyp · Dysplasia · Magnifying endoscopy · Helicobacter pylori-negative
Introduction Gastric fundic gland polyps (FGPs) are common gastric polyps in Helicobacter pylori (HP) -uninfected stomachs [1]. They consist of cystically dilated fundic glands beneath a normal gastric foveolar epithelium. FGPs occur two clinical settings, sporadic and syndromic. Syndromic FGPs often involve epithelial dysplasia [2], whereas dysplastic lesion in sporadic FGPs are rare. Here, we report a rare case of noninvasive gastric adenocarcinoma that was considered to arise from a sporadic FGP in an HP-uninfected stomach, * Yoshitaka Nawata [email protected] 1
Department of Gastroenterology, Sendai Kousei Hospital, 4‑15 Hirosemachi, Aoba‑ku, Sendai‑shi, Miyagi‑ken 980‑0873, Japan
Department of Surgical Pathology, Sapporo Kosei General Hospital, 8‑5 Kita3‑johigashi, Chuo‑ku, Sapporo‑shi, Hokkaido 060‑0033, Japan
2
which was observed by magnifying endoscopy with narrow band imaging (ME-NBI).
Case report A woman in her 70 s underwent esophagogastroduodenoscopy (EGD) owing to a heartburn 5 years earlier at another hospital, and EGD revealed reflux esophagitis and several FGPs (Fig. 1a). Subsequently, continuous administration of a proton pump inhibitor (Rabeprazole; 10 mg once daily) was sta
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