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Endoscopic Diagnosis of Gastric Adenocarcinoma of Fundic-gland Mucosa, and Mixed Fundic and Pyloric-mucosa Types Kentaro Imamura 1,2 , Kenshi Yao 1 , Hiroshi Tanabe 3 , Haruhiko Takahashi 4 , Takao Kanemitsu 1 1Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan 2Department of Gastroenterology, Ashiya Central Hospital, Ashiya, Japan 3Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan 4Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu, Japan Keyword: 胃固有粘膜型腺癌 , 胃底腺粘膜型腺癌 , 胃底腺・幽門腺粘膜混合型腺癌 , 胃底腺型腺癌 , 胃底腺型胃癌 pp.1527-1541
Published Date 2022/11/25
DOI https://doi.org/10.11477/mf.1403203046
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 This study included patients with early gastric cancer who were treated at Fukuoka University Chikushi Hospital. Patients histologically diagnosed with GA-FG(gastric adenocarcinoma of fundic-gland type), GA-FGM(fundic-gland mucosa type), GA-PGM(pyloric-gland mucosa type), GA-FPM(mixed fundic and pyloric- mucosa type), and GA-CGM(cardiac-gland mucosa type)were enrolled. Histopathological and endoscopic findings were analyzed, including 16 GA-FG, 13 GA-FGM, and 2 GA-FPM lesions. The mean tumor size was larger in GA-FPM, GA-FGM, and GA-FG, at 14.5mm, 8.0mm, and 5.0mm, respectively. Histopathological analysis showed that all lesion types often showed submucosal layer invasion. However, all lesions showed a submucosal invasion distance of <500μm and no lymphatic or venous invasions. Conventional endoscopy using the dye-spraying method revealed the difference between GA-FG and GA-FGM as well-demarcated fine granular areas were observed in GA-FGM lesions. M-NBI(magnifying endoscopy with narrow-band imaging)showed that 12 GA-FGM(92%, 12/13)lesions met the diagnostic criteria for cancer according to the VSCS(vessel plus surface classification system), whereas none of the GA-FG lesions met the same criteria(0%, 0/16). The conventional endoscopic findings of GA-FPM differed from those of GA-FG in the absence of subepithelial tumor-like lesions and dilated branching vessels and the presence of granular changes using the dye-spraying method. The conventional endoscopic findings of GA-FPM differed from those of GA-FGM in the absence of subepithelial tumor-like lesions and dilated branching vessels. M-NBI showed that 2(50%, 2/4)lesions met the VSCS diagnostic criteria for cancer.

 Our results suggest that M-NBI is a potentially useful method for GA-FGM diagnosis. The conventional endoscopic findings of GA-FPM were different from those of GA-FG and GA-FGM, and diagnosing cancer by M-NBI was difficult.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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