Clinical significance of white gastric crypt openings observed via magnifying endoscopy

Figure 1 The whiteness of crypt openings (HE, × 100). A: "White-edged dark spot" crypt openings (COs) (a round dark spot bordered by white); B: Histological image of "white-edged dark spot" COs; C: "White" COs (pure white COs without a dark spot); D: Histological image of "white" COs; E: "Dense white pit" ("DWP") COs (densely white COs resembling snowballs); F: Histological image of "DWP" COs.

Figure 2 Whiteness of crypt opening and grade of gastritis according to the updated Sydney System. Kruskal-Wallis test showed significant correlations between grades of histological inflammation (P < 0.001) and activity (P < 0.001) and whiteness of crypt openings (COs). Glandular atrophy and intestinal metaplasia were not significantly correlated with whiteness of COs. DWP: Dense white pit.

Figure 3 A case with an early undifferentiated-type gastric cancer in the middle of the corpus. A: A 67-year-old woman was found to have a depressed undifferentiated-type gastric cancer about 20 mm in diameter in an area found endoscopically to be non-atrophic; B: Magnifying endoscopy image showing minute round pits in uninvolved corpus mucosa; C: The whiteness of the crypt openings is "dense white pit" type; they resemble snowballs; D: Microscopic examination of uninvolved corpus mucosa revealed marked lymphocyte and neutrophil infiltration in the lamina propria and neutrophil infiltration within the foveolar lumens (HE stain, × 100).