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World J Gastroenterol. Dec 28, 2016; 22(48): 10523-10531
Published online Dec 28, 2016. doi: 10.3748/wjg.v22.i48.10523
Gastric adenocarcinoma of the fundic gland (chief cell-predominant type): A review of endoscopic and clinicopathological features
Masaki Miyazawa, Mitsuru Matsuda, Masaaki Yano, Yasumasa Hara, Fumitaka Arihara, Yosuke Horita, Koichiro Matsuda, Akito Sakai, Yatsugi Noda
Masaki Miyazawa, Mitsuru Matsuda, Masaaki Yano, Yasumasa Hara, Fumitaka Arihara, Yosuke Horita, Koichiro Matsuda, Akito Sakai, Yatsugi Noda, Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama 930-8550, Japan
Author contributions: Miyazawa M designed the study and wrote the manuscript; Matsuda M, Yano M, Hara Y, Arihara F, Horita Y, Matsuda K, Sakai A and Noda Y were involved in editing the manuscript.
Conflict-of-interest statement: Authors declare no Conflict of Interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Masaki Miyazawa, MD, Department of Internal Medicine, Toyama Prefectural Central Hospital, 2-2-78 Nishi-Nagae, Toyama, Toyama 930-8550, Japan. miyacchi_1985@yahoo.co.jp
Telephone: +81-76-4241531 Fax: +81-76-4220667
Received: July 27, 2016
Peer-review started: August 6, 2016
First decision: October 10, 2016
Revised: October 27, 2016
Accepted: November 23, 2016
Article in press: November 28, 2016
Published online: December 28, 2016
Abstract

Gastric adenocarcinoma of the fundic gland (chief cell-predominant type, GA-FG-CCP) is a rare variant of well-differentiated adenocarcinoma, and has been proposed to be a novel disease entity. GA-FG-CCP originates from the gastric mucosa of the fundic gland region without chronic gastritis or intestinal metaplasia. The majority of GA-FG-CCPs exhibit either a submucosal tumor-like superficial elevated shape or a flat shape on macroscopic examination. Narrow-band imaging with endoscopic magnification may reveal a regular or an irregular microvascular pattern, depending on the degree of tumor exposure to the mucosal surface. Pathological analysis of GA-FG-CCPs is characterized by a high frequency of submucosal invasion, rare occurrences of lymphatic and venous invasion, and low-grade malignancy. Detection of diffuse positivity for pepsinogen-I by immunohistochemistry is specific for GA-FG-CCP. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP. Nearly all GA-FG-CCPs are treated by endoscopic resection due to their small tumor size and low risk of recurrence or metastasis.

Keywords: Narrow-band imaging, Pepsinogen-I, Fundic gland, Gastric adenocarcinoma, Chief cell

Core tip: Gastric adenocarcinoma of the fundic gland (chief cell-predominant type, GA-FG-CCP) was recently proposed as a novel disease entity. The endoscopic and clinicopathological characteristics of GA-FG-CCP are distinct from those of gastric adenocarcinomas with an intestinal phenotype that originate from the mucosa with chronic gastritis or intestinal metaplasia. Careful endoscopic examination and detailed pathological evaluation are essential for early and accurate diagnosis of GA-FG-CCP.