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Kobori I, Katayama Y, Hayakawa F, Fujiwara T, Kuwada M, Gyotoku Y, Kusano Y, Ban S, Tamano M. Endoscopic Treatment for Submucosal Heterotopic Gastric Gland in a Case Observed over Nine Years from Development to Enlargement. Intern Med 2023; 62:2833-2837. [PMID: 36792191 PMCID: PMC10602836 DOI: 10.2169/internalmedicine.1152-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/15/2022] [Indexed: 02/16/2023] Open
Abstract
A 70-year-old Japanese man with a submucosal gastric mass that continued to increase in size underwent endoscopic submucosal dissection using the pocket creation method. Histologically, some epithelial cell nuclei were enlarged, but there was little atypia overall and no sign of malignancy, suggesting a diagnosis of submucosal heterotopic gastric gland (SHGG). SHGG that enlarges over time has been associated with gastric cancer, but a preoperative diagnosis is difficult. This case was very valuable, as it enabled us to follow the course of SHGG over a period of about nine years, from the onset to enlargement.
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Affiliation(s)
- Ikuhiro Kobori
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yasumi Katayama
- Endoscopy Center, Dokkyo Medical University Saitama Medical Center, Japan
| | - Fuki Hayakawa
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Takeshi Fujiwara
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Masaru Kuwada
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yoshinori Gyotoku
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Yumi Kusano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Japan
| | - Masaya Tamano
- Department of Gastroenterology, Dokkyo Medical University Saitama Medical Center, Japan
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Han YP, Min CC, Li YB, Chen YQ, Liu H, Tian ZB, Yin XY. Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) by endoscopic submucosal dissection: A case report. Medicine (Baltimore) 2023; 102:e33443. [PMID: 37000057 PMCID: PMC10063260 DOI: 10.1097/md.0000000000033443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
RATIONALE Gastric hamartomatous inverted polyps (GHIP) is not a common disease, and it has rarely been reported in the literature. Preoperative diagnosis is difficult due to the deep position and surface covered with normal gastric mucosa. However, with the progress of endoscopic technology, endoscopic submucosal dissection (ESD) can play a crucial role in the diagnosis and treatment of GHIP. PATIENT CONCERNS A 61-year-old Chinese man underwent gastroscopy due to abdominal pain 2 months prior that revealed chronic superficial nonatrophic gastritis with erosion and a submucosal tumor in the gastric body (an ultrasound gastroscopy was recommended). Therefore, he was admitted to our hospital for further diagnosis and treatment. DIAGNOSES A hemispherical submucosal tumor was found in the middle segment of the stomach, with a size of approximately 30 mm × 35 mm and a smooth surface without central ulceration or mucosal bridge formation. Ultrasound gastroscopy showed that the lesion was a hypoechoic mass with uniform internal echo originating from the muscularis propria. INTERVENTIONS The tumor was completely removed by using ESD. The postoperative pathological results indicated a monocystic structure in the submucosa that was not connected with the surface mucosa. The surface of the cyst was covered with foveolar cells and mucous-neck cells (part of which had low-grade intraepithelial neoplasia), and GHIP was considered to be diagnosed. OUTCOMES According to the abovementioned endoscopic and pathological features, the patient was finally diagnosed with GHIP. The patient was successfully discharged after surgery and received regular follow-up observations. LESSONS GHIP is located in the submucosa layer and has the potential risk of malignant transformation. However, it is not easy to diagnose by using gastroscopy and ultrasound gastroscopy. ESD can obtain complete specimens, which contributes to the diagnosis and treatment of GHIP.
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Affiliation(s)
- Yi-Ping Han
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Cong-Cong Min
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yu-Bei Li
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Yun-Qing Chen
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Hua Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Zi-Bin Tian
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Xiao-Yan Yin
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
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Ohtsu T, Takahashi Y, Tokuhara M, Tahara T, Ishida M, Miyasaka C, Tsuta K, Naganuma M. Gastric hamartomatous inverted polyp: Report of three cases with a review of the endoscopic and clinicopathological features. DEN OPEN 2023; 3:e198. [PMID: 36618884 PMCID: PMC9812834 DOI: 10.1002/deo2.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 01/06/2023]
Abstract
Objectives A gastric hamartomatous inverted polyp (GHIP) is a rare submucosal tumor characterized histopathologically by a submucosal inverted proliferation of cystically dilated hyperplastic gastric glands. Only 42 GHIPs have been reported in English literature. Few GHIPs have been reported to accompany adenocarcinomas. We reported on three patients with a GHIP and reviewed the clinicopathological and endoscopic features of GHIPs. Methods This study included two men and one woman with a GHIP. The endoscopic, histopathological, and immunohistochemical features of the endoscopically resected specimens were analyzed. A gene mutation analysis was also performed. Results All the tumors were located in the body of the stomach, with a median size of 20 mm. Two tumors were sessile, and the remaining tumor had a pedunculated appearance. The overlying mucosa mainly appeared normal but was reddish in one tumor. The histopathological examination of the tumors revealed a well-circumscribed and lobular submucosal proliferation of cystically dilated hyperplastic glands. The immunohistochemical analysis revealed that the MUC5AC-positive foveolar epithelium was located in the center, and MUC6-positive pseudo-pyloric or pepsinogen-I and H+/K+ ATPase-positive fundic-type glands were located at the periphery of two tumors. No carcinomatous components were noted in any of the tumors. Moreover, no significant mutations in oncogenes or tumor suppressor genes were noted. Conclusions Our review revealed that approximately three fourths of GHIP cases showed an submucosal tumor-like feature, whereas endoscopic features, including the endoscopic ultrasonography findings, were not characteristic. Because an endoscopic diagnosis of a GHIP may be difficult, complete endoscopic resection may be required for a pathological diagnosis.
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Affiliation(s)
- Takuya Ohtsu
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan,Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Yu Takahashi
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
| | - Mitsuo Tokuhara
- JCHO Hoshigaoka Medical CenterGastroenterology and HepatologyOsakaJapan
| | - Tomomitsu Tahara
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
| | - Mitsuaki Ishida
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Chika Miyasaka
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Koji Tsuta
- Department of Pathology and Division of Diagnostic PathologyKansai Medical UniversityOsakaJapan
| | - Makoto Naganuma
- Division of Gastroenterology and Hepatology, Third Department of Internal MedicineKansai Medical UniversityOsakaJapan
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Wang C, Ye F, Zhang H, Chen J, Meng L, He X. Case Report: Clinicopathological characteristics of patients with gastric cancer with features of a submucosal tumour. Front Oncol 2023; 13:1059815. [PMID: 36937382 PMCID: PMC10014732 DOI: 10.3389/fonc.2023.1059815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To investigate the clinicopathological characteristics, diagnosis and key points in the differential diagnosis of patients with gastric cancer (GC) with features of a submucosal tumour (GCSMT). Methods The clinical presentation and imaging findings of four GCSMT cases diagnosed at our centre from 2016 to 2021 were observed and their clinicopathological outcomes were analysed. The related literature was reviewed. Based on our collected data and the related literature, a total of 31 cases of GCSMT can be summarized. Results 22 out of 31 cases did not present obvious symptoms and were accidentally discovered during gastroscopic examination. Only 10 patients experienced symptoms such as gastric discomfort, upper abdominal swelling and pain, haematemesis, or haematochezia. The male to female ratio was 22:9 and the age of onset ranged from 40 to 81 years (median age: 63 years). Tumours were located in the upper and middle third of the stomach (24/31), and in the lower third(7/31). The tumour diameter ranged from 0.6 to 7.3 cm, with an average value of 2.5 cm. Endoscopically, the disease manifested as SMTs, with the gastric mucosal surface appearing normal. Most patients underwent radical gastrectomy for GC (80.6%, 25/31). The pathological diagnoses of the 31 cases of GCSMT included well- and moderately-differentiated adenocarcinoma (6/31), poorly differentiated adenocarcinoma or signet ring cell carcinoma 6/31), mucinous adenocarcinoma (9/31), lymphoepithelioma-like carcinoma (7/31), gastric adenocarcinoma of the fundic gland type (3/31). Stage T1b and T2 tumours accounted for 56.7% (17/30) and 26.7% (8/30) of all cases. Lymph node metastases were found in six cases (20.0%, 6/30), whereas distant metastasis was not observed in any of the cases. For the 16 patients whose follow-up data were available, the follow-up time was 5-66 months, during which recurrence or metastasis was not observed. Conclusion GCSMT is a rare disease that is often difficult to accurately diagnose through endoscopic biopsy. The importance of gaining an understanding of this disease lies in differentiating it from other SMTs (mostly mesenchymal tumours) to avoid misdiagnosis and missed diagnosis and enable the early diagnosis and treatment of patients.
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Affiliation(s)
- Chunnian Wang
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Fusang Ye
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Huan Zhang
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Jie Chen
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Lingli Meng
- Ningbo Clinical Pathology Diagnosis Center, Ningbo, Zhejiang, China
| | - Xianglei He
- Department of Pathology, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang, China
- *Correspondence: Xianglei He,
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Inokuchi Y, Washimi K, Watanabe M, Hayashi K, Kaneta Y, Furuta M, Machida N, Maeda S. Successful resection of gastric cancer arising from a heterotopic gastric gland in the submucosa by endoscopic submucosal dissection. Clin Case Rep 2022; 10:e5981. [PMID: 35765287 PMCID: PMC9207115 DOI: 10.1002/ccr3.5981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Heterotopic gastric gland (HGG)‐originating early gastric cancer was endoscopically resected. We resected the HGG, widely marked the perimeter outside the submucosal tumor‐like area, injected from outside the markings into the submucosa, dissected the muscular layer, and used fine‐tip hood. HGG removal and ensuring negative horizontal and vertical margins are critical. Tips of resecting heterotopic gastric gland (HGG)‐originating early gastric cancer by endoscopic submucosal dissection are described. Removal of the whole HGG and ensuring negative margins are critical to avoid unnecessary additional surgery.
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Affiliation(s)
- Yasuhiro Inokuchi
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Kota Washimi
- Department of Pathology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Mamoru Watanabe
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Kei Hayashi
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Yoshihiro Kaneta
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Mitsuhiro Furuta
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Nozomu Machida
- Department of Gastroenterology Kanagawa Cancer Center Yokohama Kanagawa Japan
| | - Shin Maeda
- Department of Gastroenterology Yokohama City University Yokohama Kanagawa Japan
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Activating KRAS and GNAS mutations in heterotopic submucosal glands of the stomach. J Gastroenterol 2022; 57:333-343. [PMID: 35188590 DOI: 10.1007/s00535-022-01863-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/07/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The heterotopic submucosal gland (HSG) is a common incidental finding in gastrectomy specimens. The majority of HSGs are small incidental lesions, which are also known as gastritis cystica profunda. However, larger lesions may appear as an inverted growth of well-organized mucosa referred to as gastric inverted polyps. METHODS To determine whether genetic alterations are involved in HSG development, we analyzed 63 gastric HSG lesions using targeted next-generation sequencing and immunohistochemistry. RESULTS Histologically, HSG lesions consistently had areas of pyloric gland differentiation with variable extent of foveolar differentiation. Although the background mucosa showed intestinal metaplasia in most cases (98%), intestinal-type epithelium was seen in only one HSG lesion (2%). Sequencing analysis identified activating KRAS, BRAF, CTNNB1, and GNAS mutations in 34 (54%), 1 (2%), 1 (2%), and 7 (11%) lesions, respectively. HSG lesions harboring a KRAS mutation were more likely to present extensive foveolar differentiation (P = 0.013) and absence of parietal cells (P = 0.0081). Five HSG lesions had a dysplastic component, and concordant genetic alterations were detected between the non-dysplastic and dysplastic areas of two lesions that were successfully analyzed. Immunohistochemical staining demonstrated diffuse expression of mutant KRAS protein in lesions with the most common genetic alteration, KRAS G12D. CONCLUSIONS Our study demonstrated that a major proportion of HSGs were proliferative lesions associated with oncogenic mutations, with more than half of lesions harboring activating KRAS mutations.
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Jung K, Park MI. Subepithelial Tumor-like Gastric Cancer. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2021. [DOI: 10.7704/kjhugr.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cancer of unknown primary inside the gastric wall identified by endoscopic submucosal dissection. Clin J Gastroenterol 2020; 14:506-510. [PMID: 33206368 DOI: 10.1007/s12328-020-01297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
We report the rare and interesting case of cancer of unknown primary (CUP) detected by endoscopic submucosal dissection (ESD). A 67-year-old man with a gastric adenoma was referred to our hospital for endoscopic treatment. Esophagogastroduodenoscopy revealed a 15-mm submucosal tumor (SMT) at the lesser curvature of the lower gastric body, near the gastric adenoma. Both lesions were resected by ESD. Pathological examination showed that the SMT was a poorly differentiated adenocarcinoma with lymphatic tissue. Additional surgical resection was performed, and the lymph nodes were found to have the same pathological findings as the SMT. These lesions were diagnosed as CUP because the obvious primary site was not detected with additional examination. The patient has been followed up for 24 months without recurrence.
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Itami H, Morita K, Nakai T, Uchiyama T, Sugimoto S, Sasaki S, Matsuoka M, Myojin T, Nitta Y, Okabe F, Fujii T, Hatakeyama K, Mitoro A, Sho M, Ohbayashi C. Gastritis cystica profunda is associated with aberrant p53 and Epstein-Barr virus in gastric cancer: A clinicopathological, immunohistochemical and in situ hybridization study. Pathol Int 2020; 71:42-50. [PMID: 33084164 DOI: 10.1111/pin.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
Gastritis cystica profunda (GCP) is a lesion characterized by cystic gastric glands within the submucosa. Some studies have reported that GCP is a precancerous lesion. Here, we investigated the association between GCP and gastric cancer. Gastric cancer specimens were taken from 1432 patients undergoing surgery or endoscopic submucosal resection and were classified as GCP or non-GCP. The clinicopathological features, immunohistochemistry and in situ hybridization expression of p53, Ki-67, KCNE2, Epstein-Barr virus (EBV) and programmed death ligand 1 (PD-L1) were compared between the two groups, as well as between GCPs and normal pyloric glands. One hundred and eighty patients (12.6%) had GCPs. In the GCP group, no cancerous lesions were found within the GCPs, but 13% were linked to GCPs and 60.2% were located above or near GCPs. Aberrant p53 expression, EBV-positive cancer cells and PD-L1 scores were significantly higher in the GCP group. The p53 score and Ki-67 labelling index were significantly higher and the KCNE2 score was significantly lower in GCPs than in pyloric glands. Although we suggest GCP is paracancerous, GCP has high proliferation activity and gastric cancer with GCP is associated with aberrant p53 and EBV. GCP is associated with aberrant p53 expression and EBV.
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Affiliation(s)
- Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Kohei Morita
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tokiko Nakai
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Sumire Sugimoto
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Shoh Sasaki
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Minami Matsuoka
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomoya Myojin
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Fumi Okabe
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
| | - Akira Mitoro
- Department of Gastroenterology and Endocrinology, Nara Medical University, Nara, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Nara, Japan
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Hayase S, Sakuma M, Chida S, Saito M, Ami H, Koyama Y, Ohki S, Kono K. Diagnosis and treatment of gastric hamartomatous inverted polyp (GHIP) using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET): a case report. Surg Case Rep 2020; 6:200. [PMID: 32761395 PMCID: PMC7410939 DOI: 10.1186/s40792-020-00951-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gastric hamartomatous inverted polyp (GHIP) is a pathological condition where enlarged gastric glands with cystic dilatation grow in the submucosa. It is difficult to excise the tissue due to its location. In addition, even if the tissue is taken correctly, making an accurate diagnosis is difficult due to foveolar epithelium in the tissue, which can be misdiagnosed as gastric mucosal epithelium. Thus, an accurate diagnosis of GHIP is rarely established from a biopsy alone preoperatively. We here report a case of GHIP with a central dimple, which was diagnosed and treated using a modified combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (modified CLEAN-NET). CASE PRESENTATION A 60-year-old man with a submucosal tumor (SMT) in the stomach was referred to our hospital by a primary care doctor. On examination, a gastrointestinal stromal tumor was suspected. Modified CLEAN-NET was performed for diagnostic and therapeutic purposes. The histopathological examination of the resected specimen showed an enlarged gland duct in the submucosal layer. This finding, along with immunostaining results, led to the diagnosis of GHIP. The postoperative course was uneventful without any symptoms. CONCLUSIONS GHIP should be considered among the differential diagnoses of SMT of the stomach. Modified CLEAN-NET may be beneficial in the removal of SMTs such as GHIP with a central dimple because it can avoid stomach deformation of the stomach and tumor dissemination.
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Affiliation(s)
- Suguru Hayase
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan.
| | - Mei Sakuma
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan
| | - Shun Chida
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan
| | - Masaru Saito
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan
| | - Hirofumi Ami
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan
| | - Yoshihisa Koyama
- Department of Surgery, Ohara General Hospital, 6-1, Uwa-machi Fukushima-shi, Fukushima, 960-8101, Japan
| | - Shinji Ohki
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1, Hikarigaoka Fukushima-shi, Fukushima, 960-1295, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1, Hikarigaoka Fukushima-shi, Fukushima, 960-1295, Japan
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Early gastric cancer with multiple submucosal heterotopic gastric gland: A case report. Mol Clin Oncol 2019; 10:583-586. [PMID: 31086667 PMCID: PMC6488944 DOI: 10.3892/mco.2019.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/17/2019] [Indexed: 12/21/2022] Open
Abstract
A case of early gastric cancer involving multiple submucosal gastric glands that was treated by distal gastrectomy was described in the present case report. An 85-year-old man was referred to our hospital for the treatment of gastric cancer. Esophagogastroduodenoscopy revealed an irregular, nodular, elevated lesion on the posterior wall of the middle third of the stomach, and biopsy specimens indicated well-differentiated tubular adenocarcinoma. Submucosal tumor (SMT)-like lesions were detected in the area adjacent to the nodular lesion, in the anterior wall side of the middle third of the stomach. Abdominal contrast-enhanced computed tomography showed cystic lesions in the middle part of the stomach, and no mass lesions in the liver. The patient underwent distal gastrectomy with regional lymphadenectomy. Macroscopic examination of the resected specimen showed an SMT-like lesion measuring 2.8×2.6 cm in contact with a superficial, depressed lesion measuring 1.7×0.9 mm in the middle third of the stomach, and another SMT-like lesion measuring 1.5×1.4 cm in diameter, which was also in the middle third of the stomach. The pathological diagnosis was well-differentiated tubular adenocarcinoma invading the gastric submucosal layer without lymph node metastasis, but with nearby submucosal heterotopic gastric gland (SHGG) detected. Following surgery, the patient remained symptom-free without evidence of recurrence for 3 months. The finding of SHGG remains a rare entity, and further studies are warranted to clarify the association between these submucosal lesions and the development of cancer.
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12
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Yamane H, Ishida M, Banzai S, Kubota T, Miyake S, Choda Y, Idani H, Shiozaki S, Okajima M. Advanced gastric cancer with features of a submucosal tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration and boring biopsy preoperatively: A case report and literature review. Int J Surg Case Rep 2019; 55:223-226. [PMID: 30776584 PMCID: PMC6378837 DOI: 10.1016/j.ijscr.2019.01.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/18/2022] Open
Abstract
Gastric carcinoma with features of a submucosal tumor is a rare condition. Gastric carcinoma with features of a submucosal tumor has unique features. Tissue sampling must be performed if gastric malignant submucosal tumor is suspected.
Introduction Gastric cancer with features of a submucosal tumor (GCSMT) is rare, and the preoperative diagnosis is very difficult. We present a case of GCSMT diagnosed by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and boring biopsy (deeper biopsy), successfully treated with distal gastrectomy and lymph node dissection. Presentation of case An 81-year-old man with a history of myocardial infarction and type 2 diabetes mellitus was admitted to our hospital for further examination of a gastric submucosal tumor. Endoscopic examination of the gastrointestinal tract showed a 30-mm submucosal tumor at the lower gastric body. Enhanced computed tomography revealed a tumor located at the lower body of the stomach and pyloric lymph node swelling. EUS-FNA and boring biopsy from the tumor revealed adenocarcinoma. Accordingly, distal gastrectomy with lymph node dissection was performed. Histopathological examination showed a poorly differentiated adenocarcinoma. Postoperative diagnosis was GCSMT with lymph node metastasis (T2, N1, M0, stage IIA). Conclusion We report a rare case of GCSMT with lymph node metastasis. Preoperative diagnosis of GCSMT is necessary to guide surgical management. EUS-FNA and boring biopsy could aid in obtaining adequate quantities of the specimens for histopathological and immunohistochemical diagnosis.
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Affiliation(s)
- Hiroaki Yamane
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Michihiro Ishida
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
| | - Seisyu Banzai
- Department of Pathology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tetsushi Kubota
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Soichiro Miyake
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shigehiro Shiozaki
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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13
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Wang X, Zhu H, Xu D. Cardia cancer surgery: total gastrectomy versus proximal gastrectomy. Panminerva Med 2019; 61:493-495. [PMID: 30657285 DOI: 10.23736/s0031-0808.18.03583-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Xiaoqing Wang
- Department of Surgery, Shangqiu First People's Hospital of Henan, Shangqiu, China -
| | - Hongjun Zhu
- Department of Thoracic Surgery, Shangqiu First People's Hospital of Henan, Shangqiu, China
| | - Dongmei Xu
- Department of Surgery, Shangqiu First People's Hospital of Henan, Shangqiu, China
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14
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Uchida A, Ozawa M, Ueda Y, Murai Y, Nishimura Y, Ishimatsu H, Okouchi Y, Ishiguro K, Hamada Y, Sasamoto R, Watanabe M, Sano N, Miyamoto R, Inagawa S, Kikuchi K. Gastric adenocarcinoma of fundic gland mucosa type localized in the submucosa: A case report. Medicine (Baltimore) 2018; 97:e12341. [PMID: 30212986 PMCID: PMC6156021 DOI: 10.1097/md.0000000000012341] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
RATIONALE Gastric adenocarcinoma of fundic gland type (GA-FG) is a new histological type of gastric cancer manifesting with differentiation into a fundic gland. Furthermore, gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a tumor that shows differentiation into not only a fundic gland but also foveolar epithelium and a mucous gland. These tumors tend to invade the submucosal layer. However, no cases of these tumors being localized only in the submucosa have been reported. Here, we present a case of GA-FGM localized in the submucosa and describe the cytological features of this tumor. To our knowledge, this is the first reported case of GA-FGM localized in the submucosa. PATIENT CONCERNS A man in his early 70s was referred to our institution because of the detection of a gastric submucosal tumor during a health checkup. DIAGNOSES Gastric adenocarcinoma of fundic gland mucosa type. INTERVENTIONS Endoscopic ultrasound-guided fine-needle aspiration (FNA), endoscopic submucosal dissection (ESD), and total gastrectomy with lymph node dissection were performed. OUTCOMES The FNA specimen showed epithelial cells with low-grade atypia. In the ESD specimen, adenocarcinoma showing a gastric fundic gland mucosa-like morphology was observed. Immunohistochemical analysis showed positive staining for pepsinogen I, H+/K+-adenosine triphosphatase, MUC6, and MUC5AC and negative staining for MUC2 and CD10, indicating tumor differentiation into fundic gland mucosa. Therefore, the tumor was diagnosed as GA-FGM, with localization in the submucosal layer. Total gastrectomy and lymph node dissection were performed because of the positive margins of the ESD specimen. Neither residual tumor nor lymph node metastasis was detected; however, many foci of heterotopic gastric glands (HGGs) were observed in the gastric wall, suggesting that GA-FGM arose from an HGG. After treatment, no recurrence was observed during a 1-year follow-up period. LESSONS Various tumors may arise from HGGs. Furthermore, when an FNA specimen shows gastric fundic gland mucosa-like epithelial cells with weak atypia, the possibility of GA-FG and GA-FGM should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Naoki Sano
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Ryoichi Miyamoto
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Satoshi Inagawa
- Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
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15
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Mori H, Kobayashi N, Kobara H, Nishiyama N, Fujihara S, Chiyo T, Ayaki M, Nagase T, Masaki T. Novel and safer endoscopic cholecystectomy using only a flexible endoscope via single port. World J Gastroenterol 2016; 22:3558-3563. [PMID: 27053847 PMCID: PMC4814641 DOI: 10.3748/wjg.v22.i13.3558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 11/09/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To apply the laparoscopic and endoscopic cooperative surgery concept, we investigated whether endoscopic cholecystectomy could be performed more safely and rapidly via only 1 port or not.
METHODS: Two dogs (11 and 13-mo-old female Beagle) were used in this study. Only 1 blunt port was created, and a flexible endoscope with a tip attachment was inserted between the fundus of gallbladder and liver. After local injection of saline to the gallbladder bed, resection of the gallbladder bed from the liver was performed. After complete resection of the gallbladder bed, the gallbladder was pulled up to resect its neck using the Ring-shaped thread technique. The neck of the gallbladder was cut using scissor forceps. Resected gallbladder was retrieved using endoscopic net forceps via a port.
RESULTS: The operation times from general anesthetizing with sevoflurane to finishing the closure of the blunt port site were about 50 min and 60 min respectively. The resection times of gallbladder bed were about 15 min and 13 min respectively without liver injury and bleeding at all. Feed were given just after next day of operation, and they had a good appetite. Two dogs are in good health now and no complications for 1 mo after endoscopic cholecystectomy using only a flexible endoscope via one port.
CONCLUSION: We are sure of great feasibility of endoscopic cholecystectomy via single port for human.
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A case of gastric adenocarcinoma of fundic gland type resected by combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET). Clin J Gastroenterol 2015; 8:393-9. [PMID: 26615600 DOI: 10.1007/s12328-015-0619-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/25/2015] [Indexed: 12/16/2022]
Abstract
A male in his eighties attended our hospital for further evaluation of gastric cancer. A gastroscopy revealed a whitish flat elevated lesion (Paris, 0-IIa) of 15 mm in diameter on the greater curvature of the proximal fornix. The preoperative diagnosis was intra-mucosal differentiated gastric cancer, and a novel therapeutic approach, combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique (CLEAN-NET) was applied and the lesion was resected in a single piece without any complications. Histopathological findings revealed atypical glandular epithelium proliferated in the mucosa and shallow layer (300 μm) of submucosa. These cells stained positive for pepsinogen-I and the final diagnosis was gastric cancer of fundic gland type (GAFT). There was no lymph-vascular involvement and free horizontal and vertical margins were confirmed. CLEAN-NET could be a therapeutic option for GAFT at low risk of lymph node metastasis because it prevents excess wall defect and exposure of cancer cells into the peritoneal cavity.
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