A 73-year-old man with type 2 diabetes mellitus, but otherwise healthy, underwent
esophagogastroduodenoscopy screening. The examination revealed red streaks and no
atrophic mucosal areas. Therefore, Helicobacter pylori infection was not suspected. Two small lesions < 2 mm in diameter and located < 1 cm
apart were observed in the fornix. Both lesions were similar: whitish and flat with
poorly defined borders ([Fig. 1]). A biopsy from the anterior-sided lesion was diagnosed as gastric adenocarcinoma
of the fundic gland type.
Fig. 1 Endoscopic findings. In the greater curvature of the fornix, two small lesions were
found adjacent to each other (arrows). Each was < 2 mm in diameter, whitish, and
flat, with poorly defined borders. They were located < 1 cm apart.
Endoscopic submucosal dissection was performed. The two closely located lesions were
resected and included in a single surgical specimen ([Video 1]). Histopathologically, carcinoma mimicking normal fundic glands with a pale basophilic
cytoplasm and nuclei located basally infiltrated the deep layer of the lamina propria
and had irregular branching structures ([Fig. 2]). The lesions had diffuse positivity for MUC6, focal positivity for H+/K+-ATPase, and negativity for MUC2, MUC5AC, CD10, and pepsinogen I. Both lesions were
diagnosed as adenocarcinomas of the fundic gland type. The patient did not present
subsequent recurrence after 2 years.
Video 1 The two closely located lesions were resected and included in a single surgical specimen.
Fig. 2 Endoscopically resected specimens. The anterior-sided lesion was 1.6 mm in diameter
and the posterior-sided lesion 1.3 mm. Carcinoma mimicking normal fundic glands infiltrated
the deep layer of the lamina propria; hematoxylin and eosin staining.
Gastric adenocarcinoma of the fundic gland type, a novel entity of gastric adenocarcinoma
proposed by Ueyama et al. [1], is commonly observed in elderly individuals and is located in the upper third of
the stomach. It originates from the deep part of normal fundic glands without atrophy
[2]. Most are solitary lesions; only three cases of multiple lesions have been reported
thus far [3]
[4]
[5]. To the best of our knowledge, this is the first case of multiple such lesions located
close enough to be endoscopically resected en masse. Multiple gastric adenocarcinomas
of this type can arise extremely close together. Thus, the adjacent mucosa must be
comprehensively examined before endoscopic treatment to prevent overlooking lesions,
which may lead to the extent of resection being improper.
Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB
Endoscopy E-Videos is an open access online section, reporting on interesting cases and new techniques
in gastroenterological endoscopy. All papers include a high quality video and all
contributions are freely accessible online. Processing charges apply (currently EUR
375), discounts and wavers acc. to HINARI are available.
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
