Characteristic Endoscopic Findings and Clinical Pathology Associated with Gastric Adenocarcinoma of Fundic Gland Mucosa Type in Patients without H. pylori Infection Kentaro Imamura 1 , Kenshi Yao 1 , Hiroshi Tanabe 2 , Satoshi Nimura 2 , Takao Kanemitsu 1 , Masaki Miyaoka 1 , Kensei Ohtsu 1 , Toshiharu Ueki 3 , Ken Kinjo 2 , Atsuko Ota 2 , Seiji Haraoka 2 , Akinori Iwashita 2,4 1Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 3Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan 4AII Pathological Image Institute, Ogoori, Japan Keyword: 胃底腺粘膜型胃癌 , 胃底腺型胃癌 , H. pylori未感染胃 , 内視鏡所見 , 胃固有粘膜型胃癌 pp.1022-1035
Published Date 2020/7/25
DOI https://doi.org/10.11477/mf.1403202091
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 Aim and Methods:We collected data regarding lesions in all cases of gastric cancer for which endoscopic or surgical resection was performed at Fukuoka University Chikushi Hospital between September 2007 and December 2019, and which were histopathologically diagnosed as either gastric adenocarcinoma of the fundic gland type or gastric adenocarcinoma of the fundic gland mucosa type. Moreover, the cases analyzed were confirmed as being free of Helicobacter pylori infection and endoscopic findings were available. We investigated the clinical pathological characteristics and characteristic endoscopic findings.

 Results:The mean tumor diameter in the fundic gland mucosa type(10 lesions, 7.7mm)tended to be larger than that in the fundic gland type(11 lesions, 4.9mm). Upon measuring the mean submucosal infiltration depths in the cases of early gastric cancer, we found that this depth was statistically significantly deeper in the fundic gland mucosa type than in the fundic gland type(p=0.020). There were 4 characteristic findings noted on normal endoscopy:(1)same/pale color(80% ; 8/10),(2)a elevated lesion resembling a subepithelial tumor(80% ; 8/10),(3)visible branching vessels(60% ; 6/10), and(4)well demarcated area with fine granular surface change visible on the surface with chromoscopy(60% ; 6/10). These findings differed from those for the fundic gland type in that well demarcated area with fine granular surface change could be observed on the surface with chromoscopy(p=0.002). Characteristic findings with NBI magnification endoscopy were(1)presence of a demarcation line(90% ; 9/10),(2)an irregular microvascular pattern(100% ; 10/10),(3)an irregular microsurface pattern(60% ; 6/10),(4)a vessel within epithelium pattern(80% ; 8/10),(5)a wider marginal crypt epithelium pattern than in the surrounding membrane(80% ; 8/10), and(6)wider intervening part between gastric crypts(90% ; 9/10). Although the NBI magnification endoscopy findings for the fundic gland mucosa lesions fulfilled the diagnostic criteria for cancer as described in the vessel plus surface classification system and the magnifying endoscopy simple diagnostic algorithm for early gastric cancer and in 90% of the cases, none of the findings from the fundic gland type lesions fulfilled these criteria(0% ; 0/11)(p=0.001).

 Conclusion:Our results demonstrated that it is highly likely that gastric adenocarcinoma of fundic gland mucosa type can be diagnosed as cancer by magnifying endoscopy with NBI.

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