H. pylori-negative Intramucosal Well-differentiated Tubular Adenocarcinoma of the Gastric Antrum with a Gastric Phenotype, Report of Two Cases Yoshitaka Nawata 1 , Shin Ichihara 2 , Dai Hirasawa 1 , Tomoki Matsuda 1 1Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan 2Department of Pathology, Sapporo-Kosei General Hospital, Sapporo, Japan Keyword: H. pylori未感染胃癌 , 胃型形質 , 分化型癌 pp.1090-1097
Published Date 2020/7/25
DOI https://doi.org/10.11477/mf.1403202100
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 We report two cases of differentiated early gastric cancer with gastric mucous phenotype in the antrum of H. pylori(Helicobacter pylori)-negative stomach. Case 1 was a man in his 40s presenting with a single elevated 3mm lesion on the anterior wall of the antrum. Case 2 was a woman in her 60s presenting with an elevated 5mm lesion on the anterior wall of the antrum, surrounded by multiple elevated erosions. In both cases, endoscopic examination showed no atrophy, negative urea breath test, and negative serum antibody to H. pylori. Because the biopsy samples taken from these lesions showed well-differentiated tubular adenocarcinoma(tub1), endoscopic submucosal dissection was performed. A histopathological diagnosis of tub1 confined to the mucosa was made. Mucosa outside the lesion composed of pyloric gland mucosa with no evidence of atrophic change or intestinal metaplasia. Tumor cells were positive for MUC5AC and MUC6, and negative for MUC2, CD10, pepsinogen I, and H/K ATPase. Previous studies show that signet-ring cell carcinoma is most common in the antrum of H. pylori-negative stomach. However, differentiated gastric cancer can also occur. Careful examination is required to observe potential single mucosal changes and prominent erosions surrounded by multiple erosions even in a regular arrangement of collecting venules-positive stomach.

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