Multiple Foveolar-type Adenomas and a Foveolar Hyperplasia in a Patient Not Infected with Helicobacter pylori, Report of a Case Chika Fukuyama 1 , Kotaro Shibagaki 1 , Hironobu Mikami 1 , Daisuke Izumi 1 , Noritsugu Yamashita 1 , Tsuyoshi Mishiro 1 , Naoki Oshima 1 , Norihisa Ishimura 1 , Shuichi Sato 1 , Shunji Ishihara 1 , Mamiko Nagase 2 , Asuka Araki 2 , Noriyoshi Ishikawa 2 , Riruke Maruyama 2 , Ryoji Kushima 3 , Yoshikazu Kinoshita 1 1Department of Gastroenterology, Faculty of Medicine, Shimane University, Izumo, Japan 2Department of Pathology, Faculty of Medicine, Shimane University, Izumo, Japan 3Department of Clinical Laboratory Medicine and Diagnostic Pathology, Shiga University of Medical Science, Otsu, Japan Keyword: 胃型腺癌 , 胃型粘液形質 , 腺窩上皮型 , Helicobacter pylori , 未感染胃癌 pp.265-272
Published Date 2019/2/25
DOI https://doi.org/10.11477/mf.1403201589
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 A male patient in his thirties was examined by upper endoscopic screening. Three small protruding lesions were identified in the middle stomach. WLE(white-light endoscopy)revealed two lesions with a bright red fine granular surface and raspberry-like appearance. NBIME(narrow-band imaging with magnification endoscopy)showed a heterogenous villous microstructure with irregular capillaries. These two lesions were endoscopically resected and histologically diagnosed as foveolar-type adenomas〔adenocarcinoma in JCGC(the Japanese classification of gastric carcinoma)〕. The remaining one lesion was light red according to WLE and displayed a gyrus-like regular microstructure with invisible capillaries in NBIME. It was also endoscopically resected on suspecting neoplasia ; however, it was histologically diagnosed as foveolar hyperplasia. The patient was diagnosed as not having any current or previous infection of H. pylori(Helicobacter pylori)based on eradication history, H. pylori serum IgG antibody levels, urea breath test, and endoscopic and histological findings.

 Foveolar-type adenoma is a rare tumor that occurs in individuals without H. pylori infection and is diagnosed as adenocarcinoma in JCGC. Gastric cancer in individuals not infected with H. pylori reportedly accounts for <1% of all gastric cancers. However, we have identified 14 patients with foveolar-type adenoma(adenocarcinoma in JCGC), which accounts for 6.6%(14/212)of all gastric cancer patients in our institution. The macroscopic findings of the tumors in this series were different from those of traditional foveolar-type adenomas reported in literature.

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