Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2017; 23(38): 7047-7053
Published online Oct 14, 2017. doi: 10.3748/wjg.v23.i38.7047
Gastric adenocarcinoma of fundic gland type spreading to heterotopic gastric glands
Shigeo Manabe, Ken-ichi Mukaisho, Takayuki Yasuoka, Fumitaka Usui, Tatsuzo Matsuyama, Ikuhiro Hirata, Yoshio Boku, Shuji Takahashi
Shigeo Manabe, Takayuki Yasuoka, Fumitaka Usui, Tatsuzo Matsuyama, Ikuhiro Hirata, Shuji Takahashi, Department of Gastroenterology, Kouseikai Takeda Hospital, Kyoto 600-8558, Japan
Ken-ichi Mukaisho, Department of Pathology, Shiga University of Medical Science, Seta, Tsukinwa-cho, Otsu, Shiga 520-2192, Japan
Yoshio Boku, Fujita Clinic, 67, Gokiya-cho, Oomiya-dori Shichijo-kudaru, Shimogyo-ku, Kyoto 600-8267, Japan
Author contributions: Manabe S was responsible for the patient, performed the endoscopic examination and treatment, and wrote the initial draft of the manuscript; Mukaisho K contributed to the histopathological diagnosis; all other authors contributed to the retrieval and interpretation of the results and critically reviewed the manuscript; all authors approved the final version of the manuscript.
Institutional review board statement: This case report was exempted from the standards of the Institutional Review Board at the Kouseikai Takeda Hospital.
Informed consent statement: The patient provided an oral informed consent prior to the conduction of the study.
Conflict-of-interest statement: We declare that there is no conflict of interest.
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: Shigeo Manabe, MD, Department of Gastroenterology, Kouseikai Takeda Hospital, 841-5, Higashi Shiokoji-cho, Shiokoji-dori Nishinotoin-higashiiru, Shimogyo-ku, Kyoto 600-8558, Japan. s-manabe@takedahp.or.jp
Telephone: +81-75-3611351 Fax: +81-75-3617602
Received: June 6, 2017
Peer-review started: June 14, 2017
First decision: July 17, 2017
Revised: August 18, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: October 14, 2017
Abstract

Herein, we present a case of gastric adenocarcinoma of fundic gland type (GA-FG) spreading to heterotopic gastric glands (HGG) in the submucosa. A 58-year-old man with epigastric pain was referred to our hospital and underwent an esophagogastroduodenoscopy. A Borrmann type II gastric cancer at the antrum and a 10 mm submucosal tumor-like lesion in the lesser curvature of the upper third of the stomach were detected. Histological examination of the biopsy specimens obtained from the submucosal tumor-like lesion suggested a GA-FG. Therefore, endoscopic submucosal dissection was performed as excisional biopsy, and histopathological examination of the resected specimen confirmed a GA-FG and HGG proximal to the GA-FG. Although the GA-FG invaded the submucosal layer slightly, the submucosal lesion of the GA-FG had a poor stromal reaction and was located just above the HGG in the submucosa. Therefore, we finally diagnosed the lesion as a GA-FG invading the submucosal layer by spreading to HGG.

Keywords: Gastric adenocarcinoma of fundic gland type, Heterotopic gastric glands, Endoscopic submucosal dissection, Paracancerous lesion, Pepsinogen-I, H/K-ATPase

Core tip: A 58-year-old man had a 10mm submucosal tumor-like lesion in the lesser curvature of the upper third of the stomach. Histological examination of the biopsy specimens suggested a gastric adenocarcinoma of fundic gland type (GA-FG), therefore, endoscopic submucosal dissection was performed as excisional biopsy. Histopathological examination of the resected specimen confirmed a GA-FG invading the submucosal layer slightly, and heterotopic gastric glands (HGG) proximal to the GA-FG. A GA-FG spreading to HGG in the submucosa was diagnosed because the submucosal lesion of the GA-FG had a poor stromal reaction and was located just above the HGG.