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Zhai Z, Hu W, Huang Z, Chen Z, Lu S, Gong W. Gastric adenocarcinoma of the fundic gland type: A review of the literature. JGH Open 2023; 7:812-825. [PMID: 38162862 PMCID: PMC10757499 DOI: 10.1002/jgh3.13014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
Background and Aim Gastric adenocarcinoma of the fundic gland type (GA-FG) is a newly described tumor entity but lacking consensus. This review summarizes the key features and controversies regarding this uncommon neoplasm. Methods We reviewed studies on GA-FG published in English from 2007 to 2021. Results We found that 327 cases (340 lesions) have been reported. GA-FG lesions originate from deep layers of the gastric mucosa, with the following characteristics on conventional white-light endoscopy examination. These lesions, macroscopically identified as submucosal tumor-like 0-IIa, tend to have a whitish discoloration without inflammation, atrophy, or intestinal metaplasia in the background mucosa. Tumors located in the upper third of the stomach are usually solitary, with an average size <10 mm. Contrastingly, magnifying endoscopy with narrow-band imaging mostly shows the absence of any demarcation line, with a regular microvascular pattern and regular microsurface pattern. GA-FGs are covered with normal foveolar epithelium, forming a so-called endless glands pattern in the deeper region, which are mainly composed of chief cells or parietal cells. Most tumors exhibit submucosal invasion, but lymphovascular invasion and nodal metastasis are rare. Regarding the treatment of GA-FG, endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) are effective treatment methods. Conclusions GA-FG is a rare tumor that typically follows a benign course. This neoplasm has distinct endoscopic and pathological features and could be treated by ESD or EMR.
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Affiliation(s)
- Zhiyong Zhai
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Wei Hu
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
| | - Zhaoyu Huang
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Zemin Chen
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Sicun Lu
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
- The Third School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Wei Gong
- Department of Gastroenterology, Shenzhen HospitalSouthern Medical UniversityShenzhenChina
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Luo R, Huang W, Chen L, Liu Y, Xu L, Zhang X, Xu C, Hou Y. SP70 is a potential biomarker to identify gastric fundic gland neoplasms. World J Surg Oncol 2022; 20:132. [PMID: 35468832 PMCID: PMC9036694 DOI: 10.1186/s12957-022-02564-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/11/2022] [Indexed: 12/13/2022] Open
Abstract
Background Gastric neoplasms with fundic gland differentiation include oxyntic gland adenomas (OGAs) and gastric adenocarcinomas of fundic gland type (GA-FGs). Due to their well-differentiated and similar morphology with normal fundic glands, it is usually challenging to identify these lesions in pathological diagnosis, especially in biopsy specimens. This study aims to explore and verify the potential role of a newly developed monoclonal antibody (McAb) NJ001 (SP70) in differentiating fundic neoplasms from non-neoplastic fundic gland lesions. Methods Twenty-three cases of histological confirmed gastric fundic gland neoplasms were obtained, including 12 cases of OGAs and 11 of GA-FGs. Fifty cases of fundic gland polyps (FGPs) were taken as the control group. Six cases of well-differentiated gastric neuroendocrine tumors (NETs) (easily misdiagnosed) were also obtained. Key clinicopathological information was collected. SP70 immunostaining was performed (with para-tumor normal fundic glands as internal control). The positive intensity and staining pattern of SP70 were analyzed and compared. Results In normal gastric mucosa, SP70 was strongly and diffusely stained on the cytoplasm in fundic glands, but not in the foveolar epithelium. Therefore, a zonal distribution of SP70 was observed in normal mucosa. FGPs (50/50, 100%) shared a similar expression pattern with normal fundic glands. In fundic gland neoplasms, a significant down-expression of SP70 was observed in both OGAs and GA-FGs. The positive rate of SP70 in fundic gland neoplasms (6/23, 26.1%) was significantly lower than that in FGPs (100%) (P<0.0001). There was no difference in SP70 expression between OGAs (3/12, 25.0%) and GA-FGs (3/11, 27.2%) group (P>0.05). In these 6 NET cases, SP70 was weak to moderate intensity in the majority of tumor cells (with a different expression pattern). Conclusion Down-expression of SP70 is a specific feature to fundic gland neoplasms including OGAs and GA-FGs. Therefore, SP70 can serve as a potential biomarker in the identification and differential diagnosis of fundic gland neoplasms.
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Affiliation(s)
- Rongkui Luo
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Wen Huang
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Lingli Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Yalan Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Lei Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Xiaolei Zhang
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China
| | - Chen Xu
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China.
| | - Yingyong Hou
- Department of Pathology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Xuhui District, Shanghai, 200032, People's Republic of China.
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