Korean J Gastroenterol.  2022 Jul;80(1):34-37. 10.4166/kjg.2022.043.

Paneth Cell Carcinoma of the Stomach

• Kim JW
• Kim GH
• Kim KB

• KMID: 2532165
• DOI: http://doi.org/10.4166/kjg.2022.043

Abstract

Paneth cell carcinoma is a rare carcinoma composed predominantly or purely of malignant Paneth cells. An 83-year-old woman presented for evaluation of an elevated lesion in the stomach. On endoscopy, a 15 mm, discolored, elevated lesion with a central depression was found on the greater curvature of the gastric lower body. Endoscopic forceps biopsy revealed chronic gastritis with intestinal metaplasia. Magnifying endoscopy revealed an irregularly oval/tubular microsurface pattern and an irregular loop microvascular pattern with a demarcation line, suggestive of early gastric cancer. Therefore, endoscopic submucosal dissection was performed. Histopathological examination revealed a well-differentiated tubular adenocarcinoma limited to the muscularis mucosae and the tumor cells contained coarse eosinophilic granules in the cytoplasm. These tumor cells were diffusely and strongly stained for lysozyme, confirming the tumor diagnosis as Paneth cell carcinoma. Herein, we report a rare case of Paneth cell carcinoma and its endoscopic and histopathologic findings.

Keyword

Gastric cancer; Endoscopic submucosal dissection; Lysozyme; Paneth cell carcinoma

Figure

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  Fig. 1 Endoscopic findings. (A) Conventional endoscopy shows a discolored, elevated lesion with a central depression, measuring approximately 15 mm in diameter, on the greater curvature of the gastric lower body. (B) Magnifying endoscopy with narrow-band imaging reveals irregularly oval and tubular microsurface patterns and an irregular loop microvascular pattern (arrows).

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  Fig. 2 Endoscopic submucosal dissection procedure. (A) An approximately 1.5 cm-sized, elevated lesion with central depression is seen on the greater curvature of the gastric lower body. (B) Chromoendoscopy with indigo carmine reveals a clearer lesion. (C, D) Circumferential mucosal incision and submucosal dissection are performed. (E) The lesion is completely removed. (F) The resected specimen.

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  Fig. 3 Histopathologic findings. (A) The tumor is a well-differentiated tubular adenocarcinoma limited to the muscularis mucosae (hematoxylin and eosin stain [H&E], ×40). (B) The tumor cells contain coarse eosinophilic granules in the cytoplasm (H&E, ×200). (C) The tumor cells are diffusely and strongly positive for lysozyme (lysozyme stain, ×40).

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