Two Cases of Gastric Adenocarcinoma of Fundic Gland Type Diagnosed Incidentally During Endoscopy in a Health Check-up

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  • 健診上部消化管内視鏡検査が契機となり診断した胃底腺型胃癌の2例
  • 症例報告 健診上部消化管内視鏡検査が契機となり診断した胃底腺型胃癌の2例
  • ショウレイ ホウコク ケンシン ジョウブ ショウカカン ナイシキョウ ケンサ ガ ケイキ ト ナリ シンダン シタ イテイセンガタ イガン ノ 2レイ

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Abstract

<p>Objective: Attention is being focused on adenocarcinoma of the fundic gland type. They are discovered in gastric mucosa not infected by Helicobacter pylori with no atrophy and infiltrate the submucosa at a high rate despite being very small. We report 2 cases diagnosed incidentally during endoscopy in a health check-up.</p><p>Case 1: Woman in her 60s. A discolored, flat protuberance with superficial dendriform vasodilation was observed in the greater curvature of the gastric fornix in endoscopy during a health check-up. There was no atrophy of the background mucosa. As the biopsy result was group 2 and gastric adenocarcinoma of the fundic gland type could not be ruled out, endoscopic submucosal dissection (ESD) was performed and the final pathological diagnosis was: “Considered to be tubular adenocarcinoma or gastric adenocarcinoma of fundic gland type, maximum diameter: 4 mm, pT1b1 (SM1)”.</p><p>Case 2: Man in his 50s. In an endoscopic examination in 20xx, a discolored wide-based protuberance with superficial dendriform vasodilation was observed near the posterior wall of the greater curvature of the upper gastric corpus and the biopsy result was group 1. There was no atrophy of the background mucosa. While there had been no change in endoscopy carried out a year later, in endoscopy after 2 years, it was slightly enlarged and hemorrhage was observed. As a biopsy suggested that pyloric adenoma should be eliminated, secondary examination was recommended but the patient was not reexamined. The result of a biopsy during endoscopy 3 years later was group 4, ESD was performed and the pathological diagnosis was: “Gastric adenocarcinoma of fundic gland type, 18 x 15 mm, pT1b2 (SM2)”.</p><p>Conclusion: We experienced one case of a tumor with a diameter of 4 mm and submucosal invasion and one case of gastric adenocarcinoma of the fundic gland type contraindicated for endoscopic treatment, which was group 1 in the initial biopsy and took 3 years for a definitive diagnosis. We should be aware of the invasive characteristics as well as the endoscopic and pathologic findings of this disease. Also, even in the absence of a definitive diagnosis through biopsy, when there are characteristic endoscopy findings, early referral to a specialist medical institution would be advisable.</p>

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