Abstract:

Objective To investigate the clinical characteristics, diagnosis and differential diagnosis of gastric adenocarcinoma of fundic gland type (GA-FG).Methods The diagnosis and treatment of a GA-FG patient were retrospectively analyzed, and the related literatures were reviewed. Results A 54-year-old woman had fading lesions of submucosal tumors (SMT) found in the upper part of the gastric body during gastroscopy. The mucosal surface of the lesion was smooth, and dilated dendritic vascular changes could be seen. Magnification endoscopy (ME) plus narrow-band imaging (NBI) showed typical honeycomb changes in the surrounding mucosa of the brown lesion, fused surface microglandular ducts, varied opening of the glandular ducts, irregular white area and surface microvessels. Ultrasonic gastroscopy showed that the mucosal lesions of the gastric body were visible, with moderate to low echo, originated from the mucosal layer; unclear boundary in the muscular layer of the mucosa; the submucosa was intact, with a size of about 0.8 cm×0.5 cm. Pathology after endoscopic resection showed: fundic adenocarcinoma with 0.3 cm×0.3 cm under the microscopy, infiltrated into the submucosa (diffuse depth of about 220 μm); negative vascular and nerve invasion; no cancer was found in the horizontal and vertical margins. Chronic inflammation of the surrounding mucosa. Immunohistochemistry: positive MUC6; negative mUC5AC; negative p53 nonsense mutation; positive desmin (incomplete mucosal muscle); positive Syn in individual cells; positive CgA in individual cells; positive CD31 and D2-40 (no tumor thrombus in the vessel) ; 10% positivity for Ki-67. Conclusion GA-FG is a new histological type of gastric cancer with unique clinical endoscopic and pathological features. The prognosis of GA-FG is good, but a long-term follow-up is needed.

Key words: stomach neoplasms, gastric adenocarcinoma of fundic gland type, endoscopy, digestive system, protuberant lesions