Korean J Gastroenterol.  2012 May;59(5):366-371. 10.4166/kjg.2012.59.5.366.

A Ten-year Follow-up of a Case with Gastric Adenoma Accompanied with Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection

• Kim JH
• Jang SY
• Hwang JA
• Ha SH
• Choi WG
• Park JS
• Han EM

• KMID: 1792836
• DOI: http://doi.org/10.4166/kjg.2012.59.5.366

Abstract

Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.

Keyword

Gastritis cystica profunda; Gastric adenoma; Endoscopic submucosal dissection

MeSH Terms

Adenoma/complications/*diagnosis/surgery
Aged, 80 and over
Female
Follow-Up Studies
Gastritis/complications/*diagnosis/ultrasonography
Gastroenterostomy
Humans
Precancerous Conditions
Stomach Neoplasms/complications/*diagnosis/surgery
Tomography, X-Ray Computed

Figure

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  Fig. 1 (A) Stomach CT finding (3 years ago). It showed an about 3×2.7 cm sized relatively well-defined low density cystic mass (arrow) in the submucosal layer with partly enhanced mucosal portion at the lesser curvature side of the low body. (B) Endoscopic ultrasonography findings. A multiseptated homogenous anechoic lesion (arrow) originating from the third layer accompanied focal wall thickening (arrow head) of the first layer.

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  Fig. 2 Endoscopic images. (A) Endoscopy showed an about 3 cm sized slight translucent submucosal tumor accompanied with whitish geographic mucosal lesion on its surface at the lesser curvature side of the lower body (3 years ago). (B) It showed an 4 cm sized submucosal tumor at the same site, but the mucosal lesion has extended (current). (C) Marking. Circumferential marking were made at several points at least 2 mm apart from the outline of mucosal adenomatous lesion by APC within the margin of gastritis cystica profunda (solid line). (D) Submucosal injection and marginal incision. After submucosal injection with Unylone® to help lift the mucosal lesion, marginal incision was done around the lesion using an IT knife 2. Fibrous septum (arrow) and cystic lesion (arrow head) of gastritis cystica profunda were shown after the incision. (E) Submucosal dissection. It showed cystic lesion of remaining gastritis cystica profunda during the dissection. (F) Remaining deep layer of normal submucosa (arrow) and cystic lesion (arrow head) were shown during dissection. (G) Remaining cystic lesion of gastritis cystica profunda after dissection. (H) Partialy resected submucosal cystic lesion with fibrous septal structure (arrow). (I) A post-endoscopic submucosal dissection (ESD) active ulcer without remnant cystic lesion (the day after ESD). (J) A post-ESD ulcer scar without remnant cystic lesion or recurrence of adenoma (6 months later after ESD).

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  Fig. 3 (A) Gross finding. The endoscopic submucosal dissection (ESD) specimen measured 3.2×2.5×0.3 cm. It contained an elevated nodular lesion. (B) Microscopic finding. The ESD specimen showed many cystic glands lined by flattend epithelium within the mucosa and low grade tubular adenoma in the surface (H&E, ×40). (C) A low grade tubular adenoma was found and the mucosa showed cystic dilatation of gastric glands (H&E, ×100).

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