Case Report
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World J Gastroenterol. Mar 28, 2013; 19(12): 2000-2004
Published online Mar 28, 2013. doi: 10.3748/wjg.v19.i12.2000
Rare case of Helicobacter pylori-related gastric ulcer: Malignancy or pseudomorphism?
Ting-Ting Li, Feng Qiu, Zhi-Qiang Wang, Lu Sun, Jun Wan
Ting-Ting Li, Jun Wan, Department of Geriatric Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China
Feng Qiu, Department of Neurology, Chinese Navy General Hospital, Beijing 100037, China
Zhi-Qiang Wang, Department of Geriatric Gastrointestinal Endoscopy, Chinese PLA General Hospital, Beijing 100853, China
Lu Sun, Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li TT and Qiu F substantially contributed to conception and design, acquisition of data, analysis and interpretation of data; Wang ZQ and Sun L drafted the article and revised it critically for important intellectual content; Wan J approved the final version to be published.
Correspondence to: Dr. Jun Wan, Department of Geriatric Gastroenterology, Chinese PLA General Hospital, Beijing 100853, China. wanjun301@126.com
Telephone: +86-10-66876266 Fax: +86-10-66876266
Received: December 7, 2012
Revised: January 5, 2013
Accepted: January 18, 2013
Published online: March 28, 2013
Abstract

Helicobacter pylori (H. pylori) is a pathogen and the most frequent cause of gastric ulcers. There is also a close correlation between the prevalence of H. pylori infection and the incidence of gastric cancer. We present the case of a 38-year-old woman referred by her primary care physician for screening positron emission tomography-computed tomography (PET-CT), which showed a nodular strong accumulation point with standardized uptake value 5.6 in the gastric fundus. Gastroscopy was then performed, and a single arched ulcer, 12 mm in size, was found in the gastric fundus. Histopathological examination of the lesion revealed chronic mucosal inflammation with acute inflammation and H. pylori infection. There was an obvious mitotic phase with widespread lymphoma. Formal anti-H. pylori treatment was carried out. One month later, a gastroscopy showed a single arched ulcer, measuring 10 mm in size in the gastric fundus. Histopathological examination revealed chronic mucosal inflammation with acute inflammation and a very small amount of H. pylori infection. The mitotic phase was 4/10 high power field, with some heterotypes and an obvious nucleolus. Follow-up gastroscopy 2 mo later showed the gastric ulcer in stage S2. The mucosal swelling had markedly improved. The patient remained asymptomatic, and a follow-up PET-CT was performed 6 mo later. The nodular strong accumulation point had disappeared. Follow-up gastroscopy showed no evidence of malignant cancer. H. pylori-associated severe inflammation can lead to neoplastic changes in histiocytes. This underscores the importance of eradicating H. pylori, especially in those with mucosal lesions, and ensuring proper follow-up to prevent or even reverse early gastric cancer.

Keywords: Helicobacter pylori, Gastric ulcer, Gastric cancer, Positron emission tomography-computed tomography, Gastroscopy