|
1
|
Maruyama H, Yamagata T, Kanno Y, Shimizu T, Itasaka T, Fujishima F, Sawai T, Ito K. White Globe Appearance-Like Findings Indicating Intralymphatic Cancer Involvement Beneath the Epithelium in Gastric Cancer. Case Rep Gastrointest Med 2024; 2024:8504987. [PMID: 39463779 PMCID: PMC11512643 DOI: 10.1155/2024/8504987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/18/2024] [Indexed: 10/29/2024] Open
Abstract
A 75-year-old female was diagnosed with a type 0-I, moderately differentiated, early gastric carcinoma on the posterior wall of the middle gastric body during esophagogastroduodenoscopy (EGD). Several small whitish structures, referred to as white globe appearances (WGAs), were noted on the oral side outside the demarcation line of the cancerous protrusion. Although this area was flat without cancerous mucosal changes on the surface, subepithelial cancer extension was suspected. The histopathology of the resected specimen revealed that the carcinoma with submucosal invasion had significant lymphatic invasion with submucosal lateral extent along lymphatic vessels. In some areas, the carcinoma within the lymphatic vessels regressed from the submucosal layer towards the mucosal lamina propria, penetrating the muscularis mucosas. The intralymphatic carcinoma reaching just beneath the epithelium was considered to manifest WGA features during endoscopy.
Collapse
Affiliation(s)
- Hiroki Maruyama
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Taku Yamagata
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Yoshihide Kanno
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takeshi Shimizu
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | - Takuho Itasaka
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| | | | - Takashi Sawai
- Department of Pathology, Sendai City Medical Center, Miyagi, Japan
| | - Kei Ito
- Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan
| |
Collapse
|
|
2
|
Iwamuro M, Kawano S, Otsuka M. Drug-induced mucosal alterations observed during esophagogastroduodenoscopy. World J Gastroenterol 2024; 30:2220-2232. [PMID: 38690017 PMCID: PMC11056913 DOI: 10.3748/wjg.v30.i16.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/24/2024] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
Several features of drug-induced mucosal alterations have been observed in the upper gastrointestinal tract, i.e., the esophagus, stomach, and duodenum. These include pill-induced esophagitis, desquamative esophagitis, worsening of gastroesophageal reflux, chemotherapy-induced esophagitis, proton pump inhibitor-induced gastric mucosal changes, medication-induced gastric erosions and ulcers, pseudomelanosis of the stomach, olmesartan-related gastric mucosal inflammation, lanthanum deposition in the stomach, zinc acetate hydrate tablet-induced gastric ulcer, immune-related adverse event gastritis, olmesartan-asso-ciated sprue-like enteropathy, pseudomelanosis of the duodenum, and lanthanum deposition in the duodenum. For endoscopists, acquiring accurate knowledge regarding these diverse drug-induced mucosal alterations is crucial not only for the correct diagnosis of these lesions but also for differential diag-nosis of other conditions. This minireview aims to provide essential information on drug-induced mucosal alterations observed on esophagogastroduodenoscopy, along with representative endoscopic images.
Collapse
Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| |
Collapse
|
|
3
|
Kiryukhin AP, Tertychnyy AS, Pavlov PV, Fedorenko AA, Nagornaya DP, Marenich NS, Losik EA, Yuryeva EY, Lapina TL. Autoimmune Gastritis: Focus on Endoscopic and Morphological Characteristics. RUSSIAN JOURNAL OF GASTROENTEROLOGY, HEPATOLOGY, COLOPROCTOLOGY 2024; 34:58-69. [DOI: 10.22416/1382-4376-2024-34-1-58-69] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
Abstract
Aim: tosystematize the literature data on endoscopic semiotics and morphological changes in the gastric mucosa in autoimmune gastritis.Key points. Autoimmune gastritis is associated with an increased risk of developing adenocarcinoma and neuroendocrine tumours of the stomach. Clarification of diagnostic criteria for autoimmune gastritis is essential for gastroenterological practice. The diagnosis is based on the results of endoscopic and histological examination, and on data from laboratory tests. Isolated atrophy of the mucous membrane of the body of the stomach, the presence of difficult-to-wash creamy mucus, changes in the mucous membrane like “shed skin”, and the presence of whitish globule-like foci are typical endoscopic signs of autoimmune gastritis. Widespread pseudopyloric metaplasia, focal intestinal and pseudopancreatic metaplasia, hyperplasia of the ridges of the mucous membrane of the body of the stomach and their relationship to the glandular layer as in the antrum allow during a morphological study considering clinical data to suspect and verify autoimmune gastritis.Conclusion. During instrumental examination, knowledge of endoscopic symptoms and pathognomonic morphological changes is important for the timely diagnosis of autoimmune gastritis.
Collapse
Affiliation(s)
- A. P. Kiryukhin
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. S. Tertychnyy
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - P. V. Pavlov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Fedorenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - D. P. Nagornaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - N. S. Marenich
- Morozov Children's City Clinical Hospital of the Moscow Health Department
| | - E. A. Losik
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. Yu. Yuryeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - T. L. Lapina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| |
Collapse
|
|
4
|
Kaibysheva V, Tykhonov S, Kashin S, Kuvaev R, Kraynova E, Baculina N, Fedorov E, Drapkina O. Algorithm of autoimmune gastritis diagnosis and treatment. RUSSIAN JOURNAL OF PREVENTIVE MEDICINE 2024; 27:101. [DOI: 10.17116/profmed202427091101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
|
|
5
|
Nishiyama N, Kobara H, Ayaki M, Fujihara S, Nakatani K, Tada N, Koduka K, Matsui T, Takata T, Chiyo T, Kobayashi N, Shi T, Fujita K, Tani J, Yachida T, Masaki T, Haruma K. White Spot, a Novel Endoscopic Finding, May Be Associated with Acid-Suppressing Agents and Hypergastrinemia. J Clin Med 2021; 10:2625. [PMID: 34203619 PMCID: PMC8232144 DOI: 10.3390/jcm10122625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 12/20/2022] Open
Abstract
White globe appearance (WGA) is defined as a microendoscopic white lesion with a globular shape underlying the gastric epithelium and is considered a marker of gastric cancer. We recently reported that endoscopically visualized white spot (WS) corresponding to WGA appeared on the nonatrophic mucosa of patients with acid-suppressing agents (A-SA) use. We evaluated patients undergoing routine esophagogastroduodenoscopy and divided the patients into an A-SA group (n = 112) and a control group (n = 158). We compared the presence of WS in both groups. We also compared WS-positive- (n = 31) and -negative (n = 43) groups within the A-SA group regarding these patients' backgrounds and serum gastrin concentrations. Comparing the A-SA group with controls, the prevalence of WS was significantly higher (31/112 vs. 2/158; p < 0.001). The number of patients with high serum gastrin concentrations was significantly higher in the WS-positive group (18/31) vs. the WS-negative group (5/43) (p < 0.001). Within the A-SA group, the prevalence of WS was also significantly higher in patients taking potassium-competitive acid blockers vs. proton-pump inhibitors (21/31 vs. 10/31, p < 0.001). The WS-positive group had a significantly greater percentage of patients, with a high serum gastrin level (p < 0.001). WS may be associated with hypergastrinemia and potassium-competitive acid blockers.
Collapse
Affiliation(s)
- Noriko Nishiyama
- Department of Gastroenterology, Nishiyama Neurological Hospital, Sakaide City 762-0023, Kagawa, Japan
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Maki Ayaki
- General Medical Center, Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City 700-8505, Okayama, Japan; (M.A.); (K.H.)
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Kaho Nakatani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Naoya Tada
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Kazuhiro Koduka
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Takanori Matsui
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tadayuki Takata
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Nobuya Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tingting Shi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Koji Fujita
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Joji Tani
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tatsuo Yachida
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, MiKi City 761-0793, Kagawa, Japan; (H.K.); (S.F.); (K.N.); (N.T.); (K.K.); (T.M.); (T.T.); (T.C.); (N.K.); (T.S.); (K.F.); (J.T.); (T.Y.); (T.M.)
| | - Ken Haruma
- General Medical Center, Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Okayama City 700-8505, Okayama, Japan; (M.A.); (K.H.)
| |
Collapse
|
|
6
|
Miwa W, Hiratsuka T, Sato K, Fujino T, Kato Y. Marked reduction in the number of white globe appearance lesions in the noncancerous stomach after exchanging vonoprazan for esomeprazole treatment: a follow-up case report. Clin J Gastroenterol 2021; 14:1046-1051. [PMID: 33993429 DOI: 10.1007/s12328-021-01437-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
Recently, an association has been suggested between development of white globe appearance lesions in the noncancerous stomach and treatment with a potassium-competitive acid blocker or a proton pump inhibitor. We previously reported two cases with development of white globe appearance lesions after vonoprazan treatment, suggesting a similar association. Here, we present the follow-up report of one of those two cases, concerning a 68-year-old woman who developed multiple white globe appearance lesions 1 year after starting vonoprazan treatment for severe gastroesophageal reflux disease leading to esophageal stricture. The patient refused to continue vonoprazan treatment after the lesions developed, and esomeprazole was initiated instead. Three months later, most of the white globe appearance lesions had disappeared, without worsening of her gastroesophageal reflux disease. Histologically, mucosal structural changes induced by vonoprazan, such as parietal cell protrusion with oxyntic gland dilatation, remained unchanged, whereas the gastric glands became less packed and a small calcification in the concentrated eosinophilic material was observed in a remaining white globe appearance cyst after esomeprazole treatment. Here, we discuss possible pathogenic mechanisms of these dramatic gastric mucosal changes observed in the present case, based on our endoscopic and histological findings.
Collapse
Affiliation(s)
- Wataru Miwa
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan.
| | - Takashi Hiratsuka
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan
| | - Ken Sato
- Division of Surgery, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| | - Takashi Fujino
- Department of Cancer Genomic Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yo Kato
- Division of Pathology, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| |
Collapse
|
|
7
|
Miwa W, Hiratsuka T, Sato K, Fujino T, Kato Y. Development of white globe appearance lesions in the noncancerous stomach after vonoprazan administration: a report of two cases with a literature review. Clin J Gastroenterol 2020; 14:48-58. [PMID: 33025345 DOI: 10.1007/s12328-020-01243-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/09/2020] [Indexed: 12/28/2022]
Abstract
White globe appearance has recently been identified as a novel endoscopic marker useful in the diagnosis of early gastric cancer. Recently, this lesion has also been reported in the noncancerous stomach, including cases with autoimmune atrophic gastritis, although the clinical significance remains unclear. We present the details of a 68-year-old woman who began vonoprazan therapy for severe gastroesophageal reflux disease causing esophageal stricture. On follow-up endoscopy 1 year after beginning vonoprazan, multiple white globe appearance lesions developed in all sections of her stomach, except for the antrum. We also detected lesions during a yearly follow-up in the noncancerous stomach of a 70-year-old man who had received vonoprazan for 3 years. Lesions in both cases constituted cystic gland dilatations containing eosinophilic material. There was no evidence of accompanying autoimmune atrophic gastritis in either patient. This report is the first to our knowledge describing newly developed white globe appearance lesions in the noncancerous stomach during follow-up in two cases who received vonoprazan. Our findings suggest that these lesions in the noncancerous stomach might be associated with vonoprazan treatment. We investigated the two cases endoscopically and histologically, and we report our findings with a literature review.
Collapse
Affiliation(s)
- Wataru Miwa
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan.
| | - Takashi Hiratsuka
- Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3-2-16 Nishiikebukuro Toshima-ku, Tokyo, 171-0021, Japan
| | - Ken Sato
- Division of Surgery, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| | - Takashi Fujino
- Department of Cancer Genomic Medicine, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yo Kato
- Division of Pathology, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
| |
Collapse
|