RASPBERRY SHAPED FOVEOLAR TYPE ADENOCARCINOMA

Aims:

Atrophic gastritis and intestinal metaplasia caused by Helicobacter pylori infection are frequently involved in gastric cancer. A novel concept, gastric adenocarcinoma of fundic gland type (GA-FG), was recently proposed to define adenocarcinomas that apparently do not involve H. pylori infection. Here, we propose the new entity of gastric adenocarcinoma of foveolar type (GA-FV) and describe its characteristic endoscopy findings.

Methods:

Subjects were 1412 patients who underwent endoscopic resection of early gastric tumors (1666 lesions) at our hospital between January 2013 and August 2018. Endoscopic findings were screened for reddish semi-pedunculated protruding lesions with a morphological raspberry-like appearance and we identified 13 patients with such GA-FV (11 men, 2 women; mean age 54.2 [range, 43 – 62] years). Clinicopathological assessment was completed for these 13 patients.

Results:

All patients were negative for H. pylori infection. Tumor location was in the upper or middle parts of the stomach in 12 patients and the elevated stomach in 1. Macroscopic type was 0-I in all patients. Tumor size was 2 – 9 (mean, 4.0)mm. Pathological examination in all patients revealed intramucosal invasive carcinoma, limited to between the proliferative zone and mucosal surface with fused irregular glands and loss of compartmentalization. Nail head-like structures were observed in the top mucosal layer. All lesions remained confined to the mucosa with no vascular invasion and were immunopositive for mucin 5AC, negative for mucin 6, and diffusely positive for Ki-67.

Conclusions:

We propose GA-FV, seen as reddish semi-pedunculated protruding lesions, as a new entity of gastric adenocarcinoma.