Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Feb 25, 2016; 8(4): 244-251
Published online Feb 25, 2016. doi: 10.4253/wjge.v8.i4.244
Gastric adenocarcinoma of fundic gland type: Endoscopic and clinicopathological features
Gen Tohda, Takeshi Osawa, Yasuyuki Asada, Masaki Dochin, Shintarou Terahata
Gen Tohda, Masaki Dochin, Department of Gastroenterology, Fukui Kosei Hospital, Fukui 918-8537, Japan
Takeshi Osawa, Yasuyuki Asada, Department of Surgery, Fukui Kosei Hospital, Fukui 918-8537, Japan
Shintarou Terahata, Department of Diagnostic Pathology, Tonami General Hospital, Tonami 939-1395, Japan
Author contributions: Tohda G wrote the manuscript; Osawa T and Asada Y contributed to the manuscript discussion; Dochin M and Terahata S reviewed the manuscript.
Institutional review board statement: This case report was reviewed and approved by the Fukui Kosei Hospital Institutional Review Board.
Informed consent statement: All involved persons gave their informed consent.
Conflict-of-interest statement: Authors have no conflict of interest relevant to 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: Gen Tohda, MD, PhD, Department of Gastroenterology, Fukui Kosei Hospital, Shimo-rokujyo 201, Fukui 918-8537, Japan. genkipapa178@yahoo.co.jp
Telephone: +81-776-413377 Fax: +81-776-413372
Received: July 28, 2015
Peer-review started: August 6, 2015
First decision: September 23, 2015
Revised: December 20, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 25, 2016
Abstract

Gastric adenocarcinoma of fundic gland type (GA-FG) with chief cell differentiation was recently proposed as an extremely rare type of gastric adenocarcinoma. Here, we report 4 cases of GA-FG with chief cell differentiation. Endoscopic features included a submucosal tumor shape or a flat shape, whitish discoloration and dilated vessels on the surface. The tumors were located in the upper or middle third of the stomach. All cases were preoperatively diagnosed as GA-FG by biopsy, and endoscopic submucosal dissection was performed. Resected specimens revealed well-differentiated adenocarcinomas resembling chief cells. Tumor cells were diffusely positive for pepsinogen-I, but partially positive for H+/K+-ATPase in scattered locations around the tumor margin. Despite the presence of minimal invasion of the carcinoma into the submucosal layer, which was observed in two cases, neither lymphatic nor venous invasion was detected in any of the cases. Finally, all cases showed less aggressive clinical behavior with low grade malignancy.

Keywords: Early gastric cancer, Low grade malignancy, Fundic gland type, Chief cells, Endoscopic submucosal dissection

Core tip: Gastric adenocarcinoma of fundic gland type (GA-FG) with chief cell differentiation is a new and extremely rare type of gastric adenocarcinoma, and the clinicopathological features of GA-FG have thus not yet been elucidated. In the present study, we discuss 4 cases of GA-FG that displayed low grade malignancy, slow-growth and less aggressive clinical behavior. Endoscopic submucosal dissection was performed and complete tumor resection was confirmed pathologically. None of the patients showed any signs of recurrence during the follow-up periods. We decided to report these rare cases because of their distinct endoscopic and clinicopathological features and unique biological behaviors.