Prevalence, clinical characteristics and treatment outcomes of oxyntic gland neoplasm: a single-center retrospective study

BACKGROUND

Oxyntic gland neoplasm (OGN) is a rare subtype of gastric cancer. The aim of this study is to evaluate the prevalence, clinicopathological features, effectiveness and safety of endoscopic treatment, as well as the prognosis of OGN.

METHODS

We retrospectively analyzed the data of patients pathologically diagnosed with OGN at our hospital from November 1, 2019 to May 1, 2023.

RESULTS

A total of 36 patients with 45 lesions were identified, resulting in a disease frequency of 0.047% (36/76,832). The mean age was 55.0 ± 7.5 years, with a male-to-female ratio of about 1:1.12. Most lesions were ≤10 mm in size (84.4%), located in the upper third of the stomach (73.3%), exhibited slight elevation (75.5%), appeared whitish (55%), had dilated blood vessels on the surface (75.5%). 16 and 21 lesions were treated by precutting endoscopic mucosal resection (EMR-P) and endoscopic submucosal dissection (ESD), respectively. No significant differences were found between EMR-P and ESD in terms of en bloc resection rate (100% vs 100%, p = 1.000), complete resection rate (100% vs 90.5%, p = 0.495), and curative resection rate (93.8% vs 90.5%, p = 1.000). No complications such as bleeding and perforation were observed. No recurrence or metastasis was observed during the follow-up period.

CONCLUSIONS

OGN is a rare tumor with unique clinical, endoscopic, and pathological characteristics. EMR-P and ESD are deemed safe and effective for treating OGNs. The relatively faster and easier EMR-P seems at least non-inferior to ESD, especially for removal of smaller OGNs. The overall prognosis is favorable.

Endoscopic Features of Gastric Epithelial Neoplasm of Fundic Gland Mucosa Lineage

The endoscopic features of gastric epithelial neoplasms of fundic gland mucosa lineage (GEN-FGML) have not been well investigated. We aimed to clarify the endoscopic features of GEN-FGML and differences between gastric adenocarcinoma of the fundic gland type (GA-FG) and fundic gland mucosa type (GA-FGM). A total of 62 GEN-FGML lesions, including 52 GA-FG and 10 GA-FGM, were retrospectively analyzed using endoscopic and clinicopathological findings to provide information of diagnostic value using white light imaging (WLI) and magnifying endoscopy with narrow-band imaging (M-NBI). GA-FG frequently presented with a whitish, submucosal tumor (SMT) shape with dilated vessels with branching architecture and background mucosa without atrophic change in WLI, an indistinct demarcation line (DL), dilatation of the crypt opening and intervening part (IP), and microvessels without distinct irregularity in M-NBI. GA-FGM frequently presented as a reddish, elevated lesion in WLI, with a distinct DL, dilatation of the IP, and an irregular microvascular pattern in M-NBI. As for an M-NBI diagnosis, five GA-FGM lesions met the diagnostic criteria for cancer, whereas none of the GA-FG lesions met the same criteria. We highlight the endoscopic features of GEN-FGML, and the differentiation between GA-FG and GA-FGM might be possible by combination of lesion color and morphology in WLI and M-NBI diagnoses.

Clinicopathological features of early stage gastric adenocarcinoma of fundic gland type: Case series

INTRODUCTION

Gastric adenocarcinoma of the fundic gland type (GA-FG) is characterized by a well-differentiated neoplasm. More than 100 cases have been reported, but only a few cases have been described in China. Therefore, its clinicopathological characteristics need to be investigated further. Herein, we report five cases and briefly review the relevant literature.

PATIENT CONCERNS

Five patients, including three women and two men, were identified in the Ningbo Clinical Pathological Diagnosis Center between March 2017 and July 2020. Patients (case 1, case 2, and case 5) underwent gastroscopy due to epigastric pain. Apart from the lesion, others were occasionally discovered on physical examination.

DIAGNOSIS

Gastric adenocarcinoma of the fundic gland type (GA-FG).

INTERVENTION

Five patients were treated with endoscopic submucosal dissection.

OUTCOMES

Surgical outcomes were good. Esophagogastroduodenoscopy showed a scar with no recurrence, and no postoperative symptoms were observed from 3 to 43 months during the follow-up.

CONCLUSION

We present five cases of well-differentiated tubular adenocarcinoma that mimicked the fundic glands. Cell differentiation by MUC2, MUC5AC, MUC6, pepsinogen-I, and H+/K+-ATPase. Immunohistochemical findings in GA-FG suggested differentiation of the fundic glands. In addition, it has a low proliferation. p53 and Her-2 were negative, and β-catenin was positive in the cytoplasm, indicating that the pathogenesis of this tumor was different from that of traditional intestinal and diffuse gastric carcinomas. In summary, this neoplasm is rare and unusual. To better understand this issue, similar cases should be monitored in the future.

Gastric adenocarcinoma of fundic gland mucosa type localized in the submucosa: A case report

RATIONALE

Gastric adenocarcinoma of fundic gland type (GA-FG) is a new histological type of gastric cancer manifesting with differentiation into a fundic gland. Furthermore, gastric adenocarcinoma of fundic gland mucosa type (GA-FGM) is a tumor that shows differentiation into not only a fundic gland but also foveolar epithelium and a mucous gland. These tumors tend to invade the submucosal layer. However, no cases of these tumors being localized only in the submucosa have been reported. Here, we present a case of GA-FGM localized in the submucosa and describe the cytological features of this tumor. To our knowledge, this is the first reported case of GA-FGM localized in the submucosa.

PATIENT CONCERNS

A man in his early 70s was referred to our institution because of the detection of a gastric submucosal tumor during a health checkup.

DIAGNOSES

Gastric adenocarcinoma of fundic gland mucosa type.

INTERVENTIONS

Endoscopic ultrasound-guided fine-needle aspiration (FNA), endoscopic submucosal dissection (ESD), and total gastrectomy with lymph node dissection were performed.

OUTCOMES

The FNA specimen showed epithelial cells with low-grade atypia. In the ESD specimen, adenocarcinoma showing a gastric fundic gland mucosa-like morphology was observed. Immunohistochemical analysis showed positive staining for pepsinogen I, H+/K+-adenosine triphosphatase, MUC6, and MUC5AC and negative staining for MUC2 and CD10, indicating tumor differentiation into fundic gland mucosa. Therefore, the tumor was diagnosed as GA-FGM, with localization in the submucosal layer. Total gastrectomy and lymph node dissection were performed because of the positive margins of the ESD specimen. Neither residual tumor nor lymph node metastasis was detected; however, many foci of heterotopic gastric glands (HGGs) were observed in the gastric wall, suggesting that GA-FGM arose from an HGG. After treatment, no recurrence was observed during a 1-year follow-up period.

LESSONS

Various tumors may arise from HGGs. Furthermore, when an FNA specimen shows gastric fundic gland mucosa-like epithelial cells with weak atypia, the possibility of GA-FG and GA-FGM should be considered.

Gastric Adenocarcinoma of the Fundic Gland Type after Endoscopic Therapy for Metachronous Gastric Cancer

A 78-year-old man underwent endoscopic submucosal dissection (ESD) for early gastric adenocarcinoma twice in 2009 and 2014. Between the procedures, he successfully completed Helicobacter pylori eradication therapy. In May 2015, upper endoscopy screening showed two elevated lesions on the gastric fundus, and en bloc resection by ESD was performed. We histopathologically diagnosed the patient to have gastric adenocarcinoma of the fundic gland type. In this case, the two lesions of gastric adenocarcinoma of the fundic gland type multifocally developed after ESD for metachronous gastric tubular adenocarcinoma. Furthermore, they appeared in the gastric fundus, where atrophy had been improved due to eradication therapy.