Endoscopic Features of Gastric Adenocarcinoma of Fundic-gland Type Hiroya Ueyama 1 , Kohei Matsumoto 1 , Takashi Yao 2 , Daiki Abe 1 , Shotaro Oki 1 , Nobuyuki Suzuki 1 , Atsushi Ikeda 1 , Noboru Yatagai 1 , Hiroyuki Komori 1 , Yoichi Akazawa 1 , Tsutomu Takeda 1 , Kumiko Ueda 1 , Kenshi Matsumoto 1 , Daisuke Asaoka 1 , Mariko Hojo 1 , Akihito Nagahara 1 1Department of Gastroenterology, Juntendo University, School of Medicine, Tokyo 2Department of Human Pathology, Juntendo University, School of Medicine, Tokyo Keyword: 胃底腺型胃癌 , 胃底腺型腺癌 , 胃底腺粘膜型腺癌 , NBI併用拡大内視鏡 pp.1006-1021
Published Date 2020/7/25
DOI https://doi.org/10.11477/mf.1403202090
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 GAFG(gastric adenocarcinoma of fundic-gland type)is a newly-recognized, special type of cancer in the Japanese classification of gastric carcinoma, 15th Edition, 2017. GAFG was also listed as a new gastric neoplasia in the WHO Classification of Tumours, 2019. GAFG is an uncommon variant of gastric adenocarcinoma with distinct clinicopathological and immunohistochemical features and which is not associated with H. pylori infection. The aim of this study was to evaluate endoscopic features of GAFG from 55 lesions. The most frequently observed features when using WLI(white light imaging)were submucosal tumor shape(60.0%), whitish color(76.4%), dilated vessels with branch architecture(58.2%)and background mucosa without atrophic change(87.3%). Macroscopically, GAFG cases were classified into 4 types, as follows:a. whitish protruded type(40.0%), b. whitish flat/depressed type(36.4%), c. reddish protruded type(20.0%), d. reddish flat/depressed type(3.6%). The most frequently observed features when using ME-NBI(magnifying endoscopy with narrow band imaging)were indistinct demarcation between lesion and surrounding mucosa(100%), dilatation of crypt opening(59.6%), dilatation of intervening part between crypts(90.4%)and blood microvessels without distinct irregularity(80.8%). Recognition of H. pylori infection state and macroscopic type, clarification of tumor exposure on tissue surface and the relationship between surface mucosa and the tumor located beneath the surface mucosa are all necessary for accurate endoscopic diagnosis of GAFG.

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