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Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report

RATIONALE: Gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a rare tumor composed of atypical cells with differentiation toward the fundic gland as well as the foveolar epithelium. Including our case, only 9 cases of GA-FGMs were reported from 2010 to 2016. CONCERNS OF THE PATIENT: An...

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Autores principales: Takahashi, Keitaro, Fujiya, Mikihiro, Ichihara, Shin, Moriichi, Kentaro, Okumura, Toshikatsu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466225/
https://www.ncbi.nlm.nih.gov/pubmed/28591047
http://dx.doi.org/10.1097/MD.0000000000007080
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author Takahashi, Keitaro
Fujiya, Mikihiro
Ichihara, Shin
Moriichi, Kentaro
Okumura, Toshikatsu
author_facet Takahashi, Keitaro
Fujiya, Mikihiro
Ichihara, Shin
Moriichi, Kentaro
Okumura, Toshikatsu
author_sort Takahashi, Keitaro
collection PubMed
description RATIONALE: Gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a rare tumor composed of atypical cells with differentiation toward the fundic gland as well as the foveolar epithelium. Including our case, only 9 cases of GA-FGMs were reported from 2010 to 2016. CONCERNS OF THE PATIENT: An 87-year-old man was referred to our institution for endoscopic resection of a gastric lesion. The tumor was classified as type 0-I + IIa according to the Paris classification. Magnifying endoscopy with narrow band imaging (ME-NBI) revealed different structures of crypts and vessels among the components, illustrating the collision of 2 types of gastric cancer. INTERVENTIONS: We performed endoscopic submucosal dissection and successfully removed the tumor en bloc. OUTCOMES: The histological findings differed markedly between the 0-I lesion and the 0-IIa lesion. The superficial part of the 0-I lesion consisted of a papillary structure, and the deeper part consisted of a tubular structure that showed inverted downward growth to the submucosal layer with the lamina muscularis mucosae. Immunohistochemically, the superficial part of the 0-I lesion was positive for MUC5AC, which had differentiated to foveolar epithelium. The deeper part was positive for pepsinogen-I and MUC6, which had differentiated to fundic gland. The 0-I lesion was diagnosed as gastric phenotype of adenocarcinoma differentiated to fundic gland mucosa with upward growth in the superficial part and downward growth in the deeper part. The 0-IIa lesion was composed of a tubular structure positive for MUC2, and it was diagnosed as an intestinal phenotype of well differentiated adenocarcinoma. The boundary was clear, and no transitional tissue was observed between the 0-I and 0-IIa lesions, suggesting that the 0-I + IIa lesion was a gastric collision tumor of GA-FGM and well differentiated adenocarcinoma. LESSONS: We herein report the first case of inverted GA-FGM colliding with well differentiated adenocarcinoma. ME-NBI can be used to diagnose GA-FGM even if the lesion collides with other types of adenocarcinoma.
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spelling pubmed-54662252017-06-15 Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report Takahashi, Keitaro Fujiya, Mikihiro Ichihara, Shin Moriichi, Kentaro Okumura, Toshikatsu Medicine (Baltimore) 4500 RATIONALE: Gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a rare tumor composed of atypical cells with differentiation toward the fundic gland as well as the foveolar epithelium. Including our case, only 9 cases of GA-FGMs were reported from 2010 to 2016. CONCERNS OF THE PATIENT: An 87-year-old man was referred to our institution for endoscopic resection of a gastric lesion. The tumor was classified as type 0-I + IIa according to the Paris classification. Magnifying endoscopy with narrow band imaging (ME-NBI) revealed different structures of crypts and vessels among the components, illustrating the collision of 2 types of gastric cancer. INTERVENTIONS: We performed endoscopic submucosal dissection and successfully removed the tumor en bloc. OUTCOMES: The histological findings differed markedly between the 0-I lesion and the 0-IIa lesion. The superficial part of the 0-I lesion consisted of a papillary structure, and the deeper part consisted of a tubular structure that showed inverted downward growth to the submucosal layer with the lamina muscularis mucosae. Immunohistochemically, the superficial part of the 0-I lesion was positive for MUC5AC, which had differentiated to foveolar epithelium. The deeper part was positive for pepsinogen-I and MUC6, which had differentiated to fundic gland. The 0-I lesion was diagnosed as gastric phenotype of adenocarcinoma differentiated to fundic gland mucosa with upward growth in the superficial part and downward growth in the deeper part. The 0-IIa lesion was composed of a tubular structure positive for MUC2, and it was diagnosed as an intestinal phenotype of well differentiated adenocarcinoma. The boundary was clear, and no transitional tissue was observed between the 0-I and 0-IIa lesions, suggesting that the 0-I + IIa lesion was a gastric collision tumor of GA-FGM and well differentiated adenocarcinoma. LESSONS: We herein report the first case of inverted GA-FGM colliding with well differentiated adenocarcinoma. ME-NBI can be used to diagnose GA-FGM even if the lesion collides with other types of adenocarcinoma. Wolters Kluwer Health 2017-06-08 /pmc/articles/PMC5466225/ /pubmed/28591047 http://dx.doi.org/10.1097/MD.0000000000007080 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4500
Takahashi, Keitaro
Fujiya, Mikihiro
Ichihara, Shin
Moriichi, Kentaro
Okumura, Toshikatsu
Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title_full Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title_fullStr Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title_full_unstemmed Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title_short Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report
title_sort inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: a case report
topic 4500
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466225/
https://www.ncbi.nlm.nih.gov/pubmed/28591047
http://dx.doi.org/10.1097/MD.0000000000007080
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