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Sreeram A, Stroobant EE, Laszkowska M, Guilford P, Shimada S, Nishimura M, Shah S, Vardhana S, Tang LH, Strong VE. Disappearing Signet Ring Cell Adenocarcinoma in Gastric Cancer Patients. Ann Surg Oncol 2024:10.1245/s10434-024-16117-8. [PMID: 39343820 DOI: 10.1245/s10434-024-16117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND The incidence of diffuse-type gastric cancer is increasing steadily in the United States, Europe, and Asia. This subtype is known for aggressive clinical characteristics and transmural invasion. However, T1a diffuse-type cancers have been observed to have a better 5-year, disease-specific mortality than stage-matched intestinal tumors, supporting a clinical difference in these early-stage cancers. METHODS Data on all living patients with T1a gastric adenocarcinoma with a finding of signet ring cell morphology on pathology and ≥1 year of follow-up from 2013 to 2023 at Memorial Sloan Kettering Cancer Center (MSK) was collected from a prospectively maintained database. Patients with known CDH1 or CTNNA1 mutations were excluded. RESULTS In 7 of 30 patients, sporadic pathologically confirmed T1a signet ring cell (diffuse) cancer identified on initial biopsy was no longer detectable upon subsequent biopsy or resection with mean follow-up of 50 months. CONCLUSIONS These cases allude to the distinct pathways of carcinogenesis in T1a signet ring cell cancers. Potential factors that may underlie the spontaneous regression of these T1a cancers include complete removal at initial biopsy, immune clearance, and lack of survival advantage conferred by signet ring cell genetic alterations in these cases. Given their more indolent behavior at an earlier stage, we suggest that these lesions can be closely followed by endoscopy in select circumstances with thorough disease assessment and an experienced care team.
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Affiliation(s)
- Aravind Sreeram
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily E Stroobant
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monika Laszkowska
- Department of Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parry Guilford
- Department of Biochemistry, Cancer Genetics Laboratory, Centre for Translational Cancer Research (Te Aho Matatu), University of Otago, Dunedin, New Zealand
| | - Shoji Shimada
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Makoto Nishimura
- Department of Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sohrab Shah
- Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha Vardhana
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura H Tang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lam SK, Lau GKK. Proton pump inhibitors are not associated with fundic gland polyps - a systematic review that takes into consideration all known confounders. Eur J Gastroenterol Hepatol 2024; 36:831-844. [PMID: 38829941 PMCID: PMC11146189 DOI: 10.1097/meg.0000000000002788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
Sporadic fundic gland polyps (FGPs) progress, albeit rarely, to dysplasia and cancer. Two meta-analyses, including 8 and 11 studies, concluded that proton pump inhibitors (PPIs) were associated with FGPs. Intervention is considered unnecessary when FGPs have a background of PPIs use. Both meta-analyses, however, disregarded known confounders: age, sex, endoscopy indications, study design (prospective or retrospective), duration of PPI use, and H. pylori infection. Confounders are known to invalidate meta-analyses. We followed PRIXMA guidelines and searched the literature for studies on FGPs in PPI-users and PPI-nonusers. In the 22 studies searched, we compared FGPs in PPI-users (n = 6534) and PPI-nonusers (n = 41 115). Heterogeneity was significant (Cochran Q = 277.8, P < 0.0001; I2 = 92.8%), annulling meta-analysis performed by blanket tallying. To offset the above confounders, we matched PPI-users and PPI-nonusers by (a) age and sex (n = 4300 and 29 307, respectively) and (b) their propensity scores derived from the confounders (n = 2950 and 4729, respectively). After both matching, FGPs were not significantly different between PPI-users and PPI-nonusers [odds ratio (OR) = 1.1, P = 0.3078; OR = 0.9, P = 0.3258, respectively]. Furthermore, FGP frequency did not correlate with increasing duration of PPI use (Pearson and Spearman correlation coefficients = 0.1162, 0.0386, P < 0.6064, 0.8646, respectively); it was not significantly different between any of the duration periods of observation, namely, <10, 10-20, 20-40, >40 months, nor was it significantly different between PPI-users and PPI-nonusers within each duration period (P > 0.05). We conclude that PPIs are not associated with FGPs, implying that a background history of PPI use is not a justification for nonintervention in the management of FGPs.
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Affiliation(s)
- Shiu Kum Lam
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre
- Former Chair & Dean of Medicine, The University of Hong Kong
| | - George Ka Kit Lau
- Gastroenterology & Hepatology of The Humanity & Health Medical Centre, Hong Kong, Hong Kong
- Liver Diseases & Transplant Centre, The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Sano W, Inoue F, Hirata D, Iwatate M, Hattori S, Fujita M, Sano Y. Sporadic fundic gland polyps with dysplasia or carcinoma: Clinical and endoscopic characteristics. World J Gastrointest Oncol 2021; 13:662-672. [PMID: 34322195 PMCID: PMC8299935 DOI: 10.4251/wjgo.v13.i7.662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/25/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are the most common gastric polyps and have been regarded as benign lesions with little malignant potential, except in the setting of familial adenomatous polyposis. However, in recent years, the prevalence of FGPs has been increasing along with the widespread and frequent use of proton pump inhibitors (PPIs). To date, several cases of FGPs with dysplasia or carcinoma (FGPD/CAs) have been reported. In this review, we evaluated the clinical and endoscopic characteristics of sporadic FGPD/CAs. Majority of the patients with sporadic FGPD/CAs were middle-aged women receiving PPI therapy and without Helicobacter pylori (H. pylori) infection. Majority of the sporadic FGPD/ CAs occurred in the body of the stomach and were sessile and small with a mean size of 5.4 mm. The sporadic FGPs with carcinoma showed redness, irregular surface structure, depression, or erosion during white light observation and irregular microvessels on the lesion surface during magnifying narrow-band imaging. In addition, sporadic FGPs, even with dysplasia, are likely to progress to cancer slowly. Therefore, frequent endoscopy is not required for patients with sporadic FGPs. However, histopathological evaluation is necessary if endoscopic findings different from ordinary FGPs are observed, regardless of their size. In the future, the prevalence of FGPs is expected to further increase along with the widespread and frequent use of PPIs and decreasing infection rate of H. pylori. Currently, it is unclear whether FGPD/CAs will also increase in the same way as FGPs. However, the trends of these lesions warrant further attention in the future.
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Affiliation(s)
- Wataru Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Fumihiro Inoue
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Daizen Hirata
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mineo Iwatate
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Santa Hattori
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Mikio Fujita
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
| | - Yasushi Sano
- Gastrointestinal Center, Sano Hospital, Kobe 655-0031, Hyogo, Japan
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Coyne JD, Thampy S. Fundic Gland Polyp With Parietal Cell Vacuolation Mimicking Signet Ring Cell Carcinoma. Int J Surg Pathol 2021; 29:503-505. [PMID: 33827319 DOI: 10.1177/1066896921994183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pseudo-signet ring parietal cell vacuolation has been described as a mimic of invasive signet ring cell carcinoma. Moreover, signet ring cell carcinoma has been described in a fundic gland polyp. This case demonstrates parietal cell vacuolation in a fundic gland polyp in a patient on a long-term proton pump inhibitor.
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Affiliation(s)
- John D Coyne
- 6197Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Manchester, UK
| | - S Thampy
- 6197Pennine Acute Hospitals NHS Trust, Royal Oldham Hospital, Manchester, UK
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Yang XM, Xu H. Clinical features of fundic gland polyps and their correlation with colorectal tumors. Shijie Huaren Xiaohua Zazhi 2020; 28:1036-1041. [DOI: 10.11569/wcjd.v28.i20.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Fundic gland polyps (FGPs) are multiple, sessile polypoid bumps formed by the gastric mucosa of the fundus and body, which are the most common type of gastric polyps and generally tend to be benign. Studies have shown that patients with FGPs have a higher risk of developing colorectal tumors (adenoma and cancer) than the general population, but their correlation is still controversial. This article is aimed to review the clinical features of FGPs and their correlation with colorectal tumors.
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Affiliation(s)
- Xue-Mei Yang
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hong Xu
- Endoscopy Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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Park KS, Lee SW, Lee J, Kim MS, Park PH, Moon SJ, Kang SB, Lee DS. Small gastric hyperplastic polyp with acute bleeding as an unusual presentation of malignancy: A case report. Medicine (Baltimore) 2018; 97:e10899. [PMID: 29851815 PMCID: PMC6392659 DOI: 10.1097/md.0000000000010899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RATIONALE Gastric hyperplastic polyps are frequently found on upper gastrointestinal endoscopy and usually asymptomatic. PATIENTS CONCERNS A 65-year-old man visited the emergency department due to melena. Emergency upper endoscopy revealed a semi-pedunculated polyp measuring 1.2 cm in diameter with blood oozing. We resected the polyp using snare polypectomy. Ulceration was noted on the polypectomy specimen and was thought to be a bleeding focus. DIAGNOSES Histopathologic findings revealed hyperplastic polyp with focal well-differentiated adenocarcinoma in the ulcerated area and involvement of the lateral resection margin by carcinoma. INTERVENTION We performed additional endoscopic resection using endoscopic submucosal dissection at the previous polypectomy site. OUTCOME At 1 year follow up, no recurrence or other distant metastasis was detected. LESSONS This is a rare case of upper gastrointestinal bleeding from a small gastric hyperplastic polyp, which was found to be adenocarcinoma. When bleeding small gastric polyps are encountered during endoscopy, the possibility of malignancy and wider resection should be considered.
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Affiliation(s)
- Kyoung Sun Park
- Division of Gastroenterology, Department of Internal Medicine
| | - Seung-Woo Lee
- Division of Gastroenterology, Department of Internal Medicine
| | - Junguee Lee
- Department of Pathology, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Sung Kim
- Division of Gastroenterology, Department of Internal Medicine
| | - Pyung Hwa Park
- Division of Gastroenterology, Department of Internal Medicine
| | - Sung Jin Moon
- Division of Gastroenterology, Department of Internal Medicine
| | - Sang-Bum Kang
- Division of Gastroenterology, Department of Internal Medicine
| | - Dong Soo Lee
- Division of Gastroenterology, Department of Internal Medicine
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Lee PL, Chen JJ, Wang SJ, Tung HD, Cheng CT, Lu NM. Fundic gland polyps is more common in patients with relative healthy gastric mucosa. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Pei-Lun Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Chi-Mei Medical Center; Tainan Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Chi-Mei Medical Center; Tainan Taiwan
| | - Szu-Jen Wang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Chi-Mei Medical Center; Tainan Taiwan
| | - Hung-Da Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Chi-Mei Medical Center; Tainan Taiwan
| | - Chun-Ta Cheng
- Division of Gastroenterology and Hepatology, Department of Internal Medicine Chi-Mei Medical Center; Tainan Taiwan
| | - Na-Mi Lu
- Department of Pathology; Chi-Mei Medical Center; Tainan Taiwan
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Straub SF, Drage MG, Gonzalez RS. Comparison of dysplastic fundic gland polyps in patients with and without familial adenomatous polyposis. Histopathology 2018; 72:1172-1179. [PMID: 29436014 DOI: 10.1111/his.13485] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/07/2018] [Indexed: 12/18/2022]
Abstract
AIMS Dysplastic fundic gland polyps (d-FGPs) typically arise in patients with familial adenomatous polyposis (FAP) but may occur in non-syndromic patients. They rarely become malignant, but their significance is unclear, especially in non-syndromic patients. We aimed to compare d-FGPs in patients with and without FAP, using clinicopathologic findings and β-catenin immunohistochemistry (IHC). METHODS AND RESULTS We identified 124 fundic gland polyps with low-grade dysplasia (LGD) or high-grade dysplasia (HGD) or indefinite for dysplasia (IFD) from 66 patients (27 with FAP; 39 non-syndromic). We recorded patient sex, age at first d-FGP, time until subsequent d-FGP (if any), history of non-gastric cancer (no patients had gastric cancer), proton-pump inhibitor use, and the presence of Helicobacter pylori. β-Catenin IHC was performed on cases with available blocks. The mean age at d-FGP diagnosis was 31 years for FAP patients and 61 years for non-syndromic patients (P < 0.0001). Sixteen FAP patients (59%) developed at least one subsequent d-FGP, as compared with 10 (27%) non-syndromic patients (P = 0.0099). The median time between d-FGP detection was 11.5 months in FAP patients and 7 months in non-syndromic patients (P = 0.82). Six FAP patients (22%) and 17 non-syndromic patients (44%) had non-gastric malignancies (P = 0.11). β-Catenin IHC showed nuclear positivity in 14 of 112 (13%) d-FGPs: 12 of 94 with LGD, two of three with HGD, and none of 15 with IFD polyps. CONCLUSIONS Familial adenomatous polyposis patients develop d-FGPs earlier and more often develop additional ones than non-syndromic patients. d-FGPs in FAP and non-syndromic patients have similar low rates of β-catenin nuclear IHC positivity. FAP and non-syndromic patients developed non-gastric cancers at similar rates, suggesting that d-FGPs may portend a general increased risk of carcinogenesis in non-syndromic patients.
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Affiliation(s)
- Shana F Straub
- Office of the Chief Medical Examiner of New York City, New York, NY, USA
| | - Michael G Drage
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Raul S Gonzalez
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
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