Gastric Adenocarcinoma Arising in a Background of Gastritis Cystica Profunda
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Gastric Adenocarcinoma Arising in a Background of Gastritis Cystica Profunda Jessica Emilia Wahi 1,2 & Michael Pagacz 3 & Kfir Ben-David 1 Received: 17 March 2020 / Accepted: 22 March 2020 # 2020 The Society for Surgery of the Alimentary Tract
Gastritis cystica profunda (GCP) is a relatively rare disease characterized by cystic dilation of gastric glands within the mucosal layer. It usually emerges at anastomotic sites of pre1 vious surgeries. Here, we report a case of gastric adenocarcinoma arising in a background of GCP in a patient with no prior abdominal surgeries. The patient is a 45-year-old Hispanic man who presented to the hospital with a 2-day history of epigastric abdominal pain and black stools. He had no previous medical or surgical history; social history was notable for daily alcohol use. Upon presentation, his hemoglobin was 6.3 and his stools were heme positive. He underwent esophagogastroduodenoscopy (EGD) that revealed an exophytic mass in the gastric body (Fig. 1). Abdominal computed tomography (CT) revealed a lobulated intraluminal gastric mass suspicious for a gastrointestinal stromal tumor (Fig. 2). Histological analysis from biopsy of this mass revealed gastric mucosa with ulceration and serrated neoplasm with atypia. There was no evidence of infection with Helicobacter pylori (H. pylori). Given these findings, the patient was referred to the surgical oncology service and taken for excisional biopsy. He underwent a diagnostic laparoscopy with wedge gastrectomy. Pathology revealed a mass of 5.2 × 4.1 × 3.2 cm dimensions of moderately differentiated mucin-producing adenocarcinoma arising in a background of gastritis cystica profunda and extending into the submucosa (Fig. 3). This biopsy had negative margins with no evidence of lymphovascular invasion.
The patient was presented at a multidisciplinary tumor board and the decision was made to do a completion gastrectomy with abdominal lymphadenectomy for proper staging. Subsequently, the patient underwent robotic total gastrectomy with esophagojejunostomy, abdominal lymphadenectomy, feeding jejunostomy, and bilateral vagotomies. There were no complications during his hospital stay and he was discharged home on post-operative day 5. There was no atypia seen in the remainder of the stomach and the ten lymph nodes taken during the operation were all free of tumor. He did not receive any chemotherapy or radiation for this T1b gastric adenocarcinoma. The etiology of GCP is not well established, but is often accompanied by chronic gastritis and H. pylori infection. It is thought that the inflammation causes erosion, which leads to the formation of submucosal cysts. It is typical to find GCP at sites of previous surgeries and is thought that the surgery promotes mucosal prolapse and herniation of glands into the submucosa. GCP has been associated with gastric cancer and recently has been considered a possible precancerous lesion.
* Jessica Emilia Wahi
1
Department of Surgery, Mount Sinai Medical Center, 4300 Alton Rd., Miami Beach, FL 3314
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