Endoscopic features of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type): a case report

Abstract

A 64-year-old Helicobacter pylori infection-naïve woman was found to have a small (≤ 10 mm) depression on the anterior wall of the upper gastric body. On white light endoscopy, the lesion appeared to be inconspicuous, whitish with dilated vessels. 0.2% indigo carmine chromoendoscopy enable better visualization of the depression. On narrow band imaging with magnification, the microsurface structure of the surrounding mucosa was absent and a network of tortuous microvessels were observed within the depressed area. Endoscopic ultrasonography indicated that the tumor was confined to the mucosa. The lesion was removed by endoscopic submucosal dissection. Histological finding of the resected specimen revealed that carcinomatous tubules existed in the deep part of the lamina propria with minimal (300 μm) submucosal invasion which were covered with the atrophic non-neoplastic foveolar epithelium. The tumor was diffusely positive for MUC6 and pepsinogen-I, while it was negative for MUC5AC and H+/K+-ATPase. A diagnosis of early stage gastric adenocarcinoma of fundic gland type (chief cell predominant type) was made.