Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report.
Inverted gastric adenocarcinoma of fundic gland mucosa type colliding with well differentiated adenocarcinoma: A case report.
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DOI：
10.1097/md.0000000000007080
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发表时间：
2017-06
期刊：
影响因子：
1.6
通讯作者：
Okumura T
中科院分区：
文献类型：
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作者：
Takahashi K;Fujiya M;Ichihara S;Moriichi K;Okumura T
胃底腺粘膜型胃腺癌(GA-FGM)是一种罕见的肿瘤，由向胃底腺和胃凹上皮分化的异型细胞组成。包括我们的病例，从2010年到2016年，只报告了9例GA-FGMS病例。一位87岁男性被转诊至本院接受胃部病变的内窥镜切除。肿瘤按PARIS分类为0-I型 + IIa型。放大胃镜窄带成像(ME-NBI)显示不同成分的隐窝和血管结构，说明两种类型的胃癌相互碰撞。我们进行了内窥镜下粘膜下剥离术，并成功地将肿瘤整块切除。0-I病变和0-IIa病变的组织学表现有显著差异。0-I损伤的浅层由乳头结构组成，深层由管状结构组成，向下生长至粘膜下层，粘膜层为肌层。免疫组织化学显示，0-I损伤浅层为MUC5AC阳性，已分化为凹上皮。深层为胃蛋白酶原-I和MUC6阳性，已分化为胃底腺。0-I病变诊断为胃型腺癌，分化为胃底腺黏膜，浅部向上生长，深层向下生长。0-IIa病变由MUC2阳性的管状结构组成，诊断为高分化腺癌的肠道表型。0-I和0-IIa病变边界清楚，未见移行组织，提示0-I + IIa病变是GA-FGM和高分化腺癌的胃碰撞瘤。我们在此报告第一例倒置GA-FGM合并高分化腺癌。即使病变与其他类型的腺癌发生碰撞，ME-NBI仍可用于诊断GA-FGM。
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. 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. We performed endoscopic submucosal dissection and successfully removed the tumor en bloc. 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. 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.