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DOI: 10.1055/s-0042-112583
Helicobacter pylori-negative intestinal-type gastric adenoma successfully treated by endoscopic submucosal dissection: a case report
Publication History
submitted 31 January 2016
accepted after revision 05 July 2016
Publication Date:
08 August 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00025476/201609/lookinside/thumbnails/519_10-1055-s-0042-112583-1.jpg)
Background and study aims: A 49-year-old woman underwent an esophagogastroduodenoscopy as part of a health check at our hospital. Endoscopic observation revealed a flat elevated lesion 6 mm in diameter in the gastric antrum (Paris Classification type IIa). Magnifying endoscopy using narrow-band imaging showed a slightly irregular micro-surface pattern with round and oval pits, as well as a regular micro-vascular pattern without a demarcation line. Atrophy and intestinal metaplasia were not recognized in the background gastric mucosa. Furthermore, Helicobacter pylori infection was not detected by histologic, serologic, and urea breath test results. Endoscopic resection was performed for histologic evaluation, and a pathologic diagnosis of intestinal-type gastric adenoma occurring in pyloric mucosa without atrophy or metaplasia was established.
Immunohistochemistry findings of the lesion showed the intestinal epithelium phenotype with positive staining for MUC2, CD10, and CDX2. Furthermore, irregular distribution with a higher positive proportion of Ki-67 was found in the lesion, indicating its malignant potential. We report here a rare case of gastric adenoma without surrounding intestinal metaplasia occurring in a Helicobacter pylori-negative patient.
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References
- 1 De Vries AC, van Grieken NC, Looman CW et al. Gastric cancer risk in patients with premalignant gastric lesions: a nationalwide cohort study in the Netherland. Gastroenterology 2008; 134: 945
- 2 Lansdown M, Quirke P, Dixon MF et al. High grade dysplasia of the gastric mucosa: a marker for gastric carcinoma. Gut 1990; 31: 977
- 3 Yao K. The endoscopic diagnosis of early gastric cancer. Ann Gastroenterol 2013; 26: 11-22
- 4 Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol 2002; 17: 39-45
- 5 Park YM, Cho E, Kang HY et al. The effectiveness and safety of endoscopic submucosal dissection compared with endoscopic mucosal resection for early gastric cancer: a systematic review and metaanalysis. Surg Endosc 2011; 25: 2666-2677
- 6 Kato M, Nishida T, Tsutsui S et al. Endoscopic submucosal dissection as a treatment for gastric noninvasive neoplasia: a multicenter study by Osaka University ESD Study Group. J Gastroenterol 2011; 46: 325-333
- 7 Tsuji Y, Ohata K, Sekiguchi M et al. Magnifying endoscopy with narrow-band imaging helps determine the management of gastric adenoma. Gastric Cancer 2012; 15: 414-418
- 8 Tajima Y, Shimoda T, Nakanishi Y et al. Gastric and intestinal phenotypic marker expression in gastric carcinomas and its prognostic significance: immunohistochemical analysis of 136 lesions. Oncology 2001; 61: 212-220
- 9 Matsuo T, Ito M, Takata S et al. Low prevalence of Helicobacter pylori-negative gastric cancer among Japanese. Helicobacter 16 (2011) 415-419
- 10 Ozaki Y, Suto H, Nosaka T et al. A case of Helicobacter pylori-negative intramucosal well-differentiated gastric adenocarcinoma with intestinal phenotype. Clin J Gastroenterol 2015; 8: 18-21