Gastritis cystica profunda in a previously unoperated stomach: A case report

Gastritis cystica profunda in an unoperated stomach mimicking a pyloric submucosal tumor and causing anorexia: A case report and literature review

BACKGROUND

Gastritis cystica profunda (GCP), commonly observed in remnant gastric anastomosis, is associated with developing gastric cancer.

CASE

This case report describes a patient with GCP in a previously unoperated stomach that mimicked a pyloric submucosal tumor and caused anorexia, which is rare in clinical practice.

PATIENT CONCERNS

A 72-year-old woman presented with loss of appetite and weight.

DIAGNOSES

Gastroscopy detected a 20 mm diameter submucosal tumor near the pylorus. Computed tomography and magnetic resonance imaging identified a cystic lesion, unlike a usual submucosal tumor in the stomach. The diagnosis was difficult, even with endoscopic ultrasound-guided fine-needle aspiration.

INTERVENTIONS

Surgery was performed for diagnosis and treatment. The lesion was resected using a submucosal dissection technique after an incision of the gastric wall during open laparotomy. Histopathological examination confirmed the diagnosis of GCP and revealed no dysplasia or cancer.

OUTCOMES

Anorexia resolved after the surgery. Residual or recurrent lesions were not detected during follow-up examinations performed 1 year after surgery.

LESSONS

GCP occurring in a previously unoperated stomach as a macroscopic lesion like a submucosal tumor causing some symptoms is rare. GCP is associated with a risk of developing cancer. Therefore, careful evaluation and management during treatment are required.

Gastritis Cystica Profunda: A Rare Disease, a Challenging Diagnosis, and an Uncertain Malignant Potential: A Case Report and Review of the Literature

Gastritis cystica profunda (GCP) has been defined as a rare submucosal benign gastric lesion with cystic gland growth. Due to its unclear etiopathogenesis, this lesion is often misdiagnosed and mistaken for other gastric masses. Currently, a standardized treatment for GCP lesions is still missing. Here, we illustrate a case of a patient admitted to our general surgery department for melena and general discomfort. No history of peptic ulcer or gastric surgery was present. Upper GI endoscopy was performed, showing a distal gastric lesion with a small ulceration on the top. CT-scan and endoscopic ultrasound confirmed the presence of the lesion, compatible with a gastric stromal tumor, without showing any eventual metastasis. Surgical gastric resection was performed. Histological findings were diagnostic for GCP, with cistically ectasic submucosal glands, chronic inflammation, eosinophilic infiltration and foveal hyperplasia. GCP is a very exceptional cause of upper-GI bleeding with specific histological features. Its diagnosis as well as its therapy are challenging, resulting in several pitfalls. Even though it is a rare entity, GCP should always be considered in the differential diagnosis of gastric submucosal lesions.

Synchronous gastric MALT lymphoma and gastric adenocarcinoma of fundic gland type arising from a hamartomatous inverted polyp in a Helicobacter pylori naive patient

We present a rare case that showed the coexistence of gastric cancer and mucosa-associated lymphoid tissue (MALT) lymphoma in Helicobacter pylori-naive stomach. A 72-year-old man was followed up after surgery for epithelial carcinoma of the glottis at the Department of Otolaryngology. He underwent an upper gastrointestinal endoscopy for an abnormal PET-CT accumulation, which revealed gastric adenocarcinoma of fundic gland type in the gastric fundus and MALT lymphoma in the upper gastric body. Hence, we performed an endoscopic submucosal dissection for gastric cancer and diagnosed gastric adenocarcinoma of fundic gland type derived from a hamartomatous-inverted polyp. Subsequently, Gastric MALT lymphoma was treated with radiation therapy because the API2-MALT1 gene was positive and the Helicobacter pylori infection was negative. A complete response was observed. Even in Hp-naive stomachs, cases such as the present case are complicated by special types of gastric cancer and MALT lymphoma, and endoscopic examination should be performed with these diseases in mind.

Computed tomography features and clinical characteristics of gastritis cystica profunda

Background

The diagnostic evidence of gastritis cystica profunda (GCP) are not adequately described due to its extremely low morbidity. This study aimed to analyze and summarize the comprehensive CT features and clinical characteristics of patients with GCP.

Results

Nineteen patients were enrolled, including eight men and eleven women, with a mean age of 55.53 years. Only one patient had the history of gastric polypectomy. Among the nineteen cases, two cases were in the gastric cardia, four in the gastric fundus, eight in the gastric body and five in the gastric antrum. The shapes were sphere in thirteen patients, hemisphere in five patients and diffuse in one patient. The mean size of eighteen local lesions was 1.63 cm. The cystic changes in submucosa were detected in fifteen patients. Compared with the pancreas, most GCP lesions were hypo-attenuated on unenhanced CT (n = 8), in arterial phase (AP) (n = 17) and venous phase (VP) (n = 11). Fifteen patients had the peak enhancement in VP and two in AP. The rim-like enhancement with central low attenuation was clearly observed in thirteen patients. For the GCP accompanied by adenocarcinoma, the enhancement peak was present in AP and the gradual expansion of enhancement area was in VP. All patients underwent surgical or endoscopic resection. Sixteen cases had remission of symptoms and no recurrence.

Conclusions

The careful analysis of CT features and clinical characteristics can provide support for deepening the understanding of the GCP. However, a more accurate diagnosis depends on histopathological features.

Gastritis cystica profunda: clinical and pathologic study of seven cases and review of literature

Gastritis cystica profunda (GCP) is a rare lesion characterized by hyperplasia and cystic dilatation of the gastric glands in the submucosal layer. Here we report seven cases of GCP. The patients are 5 women and 2 men with a mean age of 62 (range, 42-82) years at the time of diagnosis. The patients presented with abdominal distension, sour regurgitation, and heartburn. One case had the previous gastric surgery and the other six cases had no special history. The lesions were located in the fundus (4/7), corpus (1/7), cardia (1/7), and antrum (1/7). Endoscopic analysis revealed pedunculated polyps, or a dome-shaped polyp. Histologically, all cases showed dilated tubular glands, mainly located in the submucosa, among the muscularis mucosa, and occasionally in the lamina propria. The glands were lined by bland single columnar epithelium with infolding features in some areas. Mitotic activity and marked cellular atypia were not present. The stroma in some cases was mildly edematous with infiltrated lymphocytes and plasma cells. There was no epithelial dysplasia in the overlying mucosa. Immunohistochemically, the Ki-67 index was < 1%. P53 immunostaining was generally characterized as wild type in all cases. Based on the morphology of the glands and the cells and the possible mechanism of hyperplasia and cystic dilatation of the gastric glands, it is easy to differentiate GCP from a well-differentiated adenocarcinoma.

Bile reflux gastritis cystica profunda: A case report and literature review

RATIONALE

Gastritis cystica profunda (GCP) is a rare gastric lesion involving cystic dilation of the gastric glands extending into the submucosa. It is usually observed at anastomotic sites in the stomach of patients who have undergone gastric procedures. Bile reflux GCP is rare in patients who have not undergone gastric surgery. Here, we report a rare case of a patient with GCP associated with bile reflux, who had no history of gastric surgery.

PATIENT CONCERNS

A 50-year-old man presented with intermittent abdominal fullness for 2 years, along with nausea. He had never undergone gastric surgery. Endoscopic ultrasonography (EUS) showed a thickened gastric wall and an echo-poor submucosal layer of the gastric fundus. A 3 cm × 2 cm × 1.5 cm lesion was noted.

DIAGNOSIS

Bile reflux GCP INTERVENTIONS:: Endoscopic retrograde cholangiopancreatography and endoscopic submucosal dissection (ESD) were performed, and the lesion was removed. Conventional pathological examination revealed GCP with glands hyperplasia and a yellow-brown deposit, which was considered bile. The findings were consistent with a diagnosis of GCP without malignancy.

OUTCOMES

Upper gastrointestinal barium meal revealed postoperative changes at the gastric fundus. Gastroscopy performed at 6 months after surgical resection showed superficial gastritis with bile reflux.

LESSONS

The findings suggest that GCP etiology varies and that GCP can be caused by bile reflux but without malignancy. Additionally, GCP is not limited to patients who have previously undergone gastric surgery. Moreover, it is difficult to identify. EUS and ESD might be good approaches for the diagnosis and treatment of GCP.

Synchronous double superficial mixed gastrointestinal mucus phenotype gastric cancer with gastritis cystica profunda and submucosal lipoma: A case report

INTRODUCTION

Synchronous double superficial gastric cancer with gastritis cystica profunda (GCP) and submucosal lipoma is a rare disease and is difficult to diagnose and treat.

CASE PRESENTATION

A 61-year-old man was referred to our hospital with upper abdominal discomfort for the past 10 days. One year ago, the patient underwent surgery for duodenal ulcer and perforation. The diseases were diagnosed by magnifying endoscopy with narrowband imaging and pathological methods. Both mucosal lesions with a submucosal yellow-colored nodule were completely resected by endoscopic submucosal dissection and additional proximal gastrectomy was performed on the cancer embolus in the submucosal vena cava. The patient was finally diagnosed with synchronous double superficial well differentiated adenocarcinoma (mixed gastrointestinal mucus phenotype) with embolus in submucosal vena cava, coexisting with gastritis cystica profunda and submucosal lipoma. Final TNM classification was T1b (sm1) N0M0, and pathological stage was IA. The postoperative course was uneventful, and no recurrence or metastasis was observed during the 5-month follow-up period.

CONCLUSION

The diagnosis and treatment of synchronous double superficial gastric cancer with GCP and submucosal lipoma is challenging. In addition, elastic fiber staining and immune marker staining is effective and should be considered for diagnosis.

Well-differentiated adenocarcinoma may be misdiagnosed as gastritis cystica profunda

Gastric cancer (GC) is one of the most common malignant tumors in China. The low detection rate of early GC is one of the reasons for its high mortality rate. Thanks to the application of new gastroscopy technology, the detection rate of early GC has increased. Highly differentiated adenocarcinoma accounts for about 70% of all early GC cases; however, well-differentiated adenocarcinoma is difficult to diagnose because of its non-significant structural abnormality and cellular atypia. Gastritis cystica profunda is a rare disease characterized by the presence of the gastric intrinsic gland in the muscularis mucosa and/or submucosa, which is easily confused with highly differentiated adenocarcinoma. Therefore, attention should be paid to the identification of these two different entities in the clinical work.

Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report

RATIONALE

Gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a rare tumor composed of atypical cells with differentiation toward the fundic gland as well as the foveolar epithelium. Including our case, only 9 cases of GA-FGMs were reported from 2010 to 2016.

CONCERNS OF THE PATIENT

An 87-year-old man was referred to our institution for endoscopic resection of a gastric lesion. The tumor was classified as type 0-I + IIa according to the Paris classification. Magnifying endoscopy with narrow band imaging (ME-NBI) revealed different structures of crypts and vessels among the components, illustrating the collision of 2 types of gastric cancer.

INTERVENTIONS

We performed endoscopic submucosal dissection and successfully removed the tumor en bloc.

OUTCOMES

The histological findings differed markedly between the 0-I lesion and the 0-IIa lesion. The superficial part of the 0-I lesion consisted of a papillary structure, and the deeper part consisted of a tubular structure that showed inverted downward growth to the submucosal layer with the lamina muscularis mucosae. Immunohistochemically, the superficial part of the 0-I lesion was positive for MUC5AC, which had differentiated to foveolar epithelium. The deeper part was positive for pepsinogen-I and MUC6, which had differentiated to fundic gland. The 0-I lesion was diagnosed as gastric phenotype of adenocarcinoma differentiated to fundic gland mucosa with upward growth in the superficial part and downward growth in the deeper part. The 0-IIa lesion was composed of a tubular structure positive for MUC2, and it was diagnosed as an intestinal phenotype of well differentiated adenocarcinoma. The boundary was clear, and no transitional tissue was observed between the 0-I and 0-IIa lesions, suggesting that the 0-I + IIa lesion was a gastric collision tumor of GA-FGM and well differentiated adenocarcinoma.

LESSONS

We herein report the first case of inverted GA-FGM colliding with well differentiated adenocarcinoma. ME-NBI can be used to diagnose GA-FGM even if the lesion collides with other types of adenocarcinoma.