Korean J Gastroenterol.  2023 Jun;81(6):259-264. 10.4166/kjg.2023.019.

Endoscopic Resection for Gastric Adenocarcinoma of the Fundic Gland Type: A Case Series

• Lee HJ
• Kim GH
• Joo DC
• Lee MW
• Lee BE
• Kim K

• KMID: 2543446
• DOI: http://doi.org/10.4166/kjg.2023.019

Abstract

The fundic gland type (GA-FG) of gastric adenocarcinoma is a rare variant of gastric cancer recently included in the 5th edition of the World Health Organization’s classification of digestive system tumors. Five patients with GA-FG underwent an endoscopic resection at our institution. None of the patients had a Helicobacter pylori infection. Four lesions were located in the upper third of the stomach, and one was in the lower third. Three lesions had a IIa shape, while two resembled a subepithelial tumor. An endoscopic submucosal dissection was performed in four patients and endoscopic mucosal resection in one. Tumor cells were composed of well-differentiated columnar cells mimicking fundic gland cells, and the median tumor size was 10 mm. Three lesions exhibited submucosal invasion. No lymphatic or venous invasion was observed. Tumor cells were positive for MUC6 in all five cases; one case was focally positive for MUC5AC. No recurrence was observed during a median follow-up period of 13 months. An endoscopic resection can be a safe treatment modality for GA-FG, considering its small size and low risk of recurrence or metastasis. (Korean J Gastroenterol 2023;81:259-264)

Keyword

Chief cells, gastric; Gastric cancer; Endoscopic submucosal dissection

Figure

• 

  Fig. 1 A representative case of gastric adenocarcinoma of the fundic gland type (Case 2). (A) Conventional endoscopy shows a subepithelial tumor-like lesion on the greater curvature of the gastric upper body. (B) Magnifying endoscopy with narrow-band imaging shows irregular microsurface and microvascular patterns with a demarcation line. (C) On endoscopic ultrasound, the tumor extends up to the upper portion of the submucosal layer. (D, E) Traction-assisted endoscopic submucosal dissection is performed. (F) A resected specimen.

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  Fig. 2 A representative case of gastric adenocarcinoma of the fundic gland type (Case 4). (A, B) Conventional endoscopy and narrow-band imaging show a discolored, slightly elevated lesion on the anterior wall of the gastric fundus. Dilated blood vessels are observed on the surface of the lesion. (C-E) Traction-assisted endoscopic submucosal dissection is performed. (F) A resected specimen.

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  Fig. 3 Histopathological findings (Case 2). (A) Tumor arises from the deep layer of the lamina propria and invades the submucosal layer. Most of the surface is covered with non-atypical foveolar epithelium (H&E stain, ×40). (B) Tumor is composed of well-differentiated columnar cells mimicking the fundic gland cells with mild nuclear atypia (H&E stain, ×200). (C, D) Tumor is diffusely positive for MUC6 stain (C) but negative for MUC5AC stain (D) (immunohistochemical stain, ×40).

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