Korean J Gastroenterol.  2010 May;55(5):325-330. 10.4166/kjg.2010.55.5.325.

Gastritis Cystica Profunda Accompanied by Multiple Early Gastric Cancers

• Moon SY
• Kim KO
• Park SH
• Yoo KS
• Park CH
• Kim JH
• Park CK
• Jun SY

• KMID: 1718338
• DOI: http://doi.org/10.4166/kjg.2010.55.5.325

Abstract

Gastritis cystica profunda (GCP) is a rare disease which shows multiple cystic gastric glands within the submucosa of the stomach. GCP lesions mainly develop at the site of gastroenterostomy and exhibit benign behavior. However, there have been a number of debates over its malignant potential. Several reports have documented GCP accompanied by gastric carcinomas, but the relationship between the two conditions remains uncertain. Here we report two cases of GCP with dysplasia accompanied by synchronous multiple early gastric cancers without previous gastric surgery.

Keyword

Gastritis cystica profunda; Gastric cancer; Dysplasia

MeSH Terms

Aged
Cysts/*diagnosis/pathology
Early Detection of Cancer
Gastric Mucosa/pathology
Gastritis/complications/*diagnosis/pathology
Humans
Male
Neoplasms, Multiple Primary/*diagnosis/pathology
Stomach Neoplasms/complications/*diagnosis/pathology

Figure

• 

  Fig. 1. The gastroscopy images showed two depressed nodular lesions (arrows) at the prepyloric antrum and several small smoothly elevated mucosal lesions at anterior wall of the lower body.

• 

  Fig. 2. The small smoothly elevated lesions (arrows) at anterior (A) and posterior (B) walls of the lower body were slightly en-larged compared with previous examination. (C) The EUS image of the elevated lesion at posterior wall of the lower body showed a hypoechoic mass originating from the third layer, sug-gesting a submucosal cyst.

• 

  Fig. 3. (A) The EMR specimen of posterior wall of lower body showed numerous tiny cysts lined by flattened epithelium within the submucosa, consistent with gastritis cystica profunda (H&E, ×40). (B) EMR specemien of anterior wall of lower body. The cancer cells focally infiltrated to the superficial submucosal layer, and multiple cysts lined by flattened epithelium were present within the submucosa, consistent with gastritis cystica profunda (H&E, ×100).

• 

  Fig. 4. Esophagogastroduodenoscopy showed (A) a central irregular depressed reddish mucosal lesion with slighltly elevated nodular mar-gin at greater curvature of the antrum and (B) a focal flat elevated lesion at anterior wall of the lower body.

• 

  Fig. 5. (A) Some cysts of gastritis cystica profunda showed stratifications of proliferating epithelial cells (H&E, ×100) with (B) mild cy-tologic atypia (H&E, ×200). No mitosis was seen. In the mucosa above the GCP, adenocarcinomatous glandular cells were seen.

Reference

1. Franzin G, Novelli P. Gastritis cystica profunda. Histopatholo-gy. 1981; 5:535–547.

2. Littler ER, Gleibermann E. Gastritis cystica polyposa. (Gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia). Cancer. 1972; 29:205–209.

3. Iwanaga T, Koyama H, Takahashi Y, Taniguchi H, Wada A. Diffuse submucosal cysts and carcinoma of the stomach. Cancer. 1975; 36:606–614.

4. Fonde EC, Rodning CB. Gastritis cystica profunda. Am J Gastroenterol. 1986; 81:459–464.

5. Bé chade D, Desramé J, Algayres JP. Gastritis cystic profunda in a patient with no history of gastric surgery. Endoscopy. 2007; 39(suppl 1):E80–E81.

6. Kondo K. Duodenogastric reflux and gastric stump carcinoma. Gastric Cancer. 2002; 5:16–22.

7. Kim W, Park SC, Lee JY, et al. A case of gastric adenocarcinoma diagnosed after being followed up as submucosal tumor for 10 years. Korean J Gastointest Endosc. 2001; 37:291–295.

8. Yanagiwa H, Matsuzaki O, Ishihara A, Yoshimura H. Heterotopic gastric glands in the submucosa of the stomach. Acta Pathol Jpn. 1979; 29:347–350.

9. Park KH, Seong SG, Kim DK, et al. A case of Menetrier's disease association with gastritis profonda. Korean J Med. 1995; 48:811–815.

10. Okada M, Iizuka Y, Oh K, Murayama H, Maekawa T. Gastritis cystica profunda presenting as giant gastric mucosal fold: the role of endoscopic ultrasonography and mucosec-tomy in the diagnostic work-up. Gastrointest Endosc. 1994; 40:640–644.

11. Qizilbash AH. Gastritis cystica and carcinoma arising in old gastrojejunostomy stoma. Can Med Assoc J. 1975; 112:1432–1433.

12. Kurland J, DuBois S, Behling C, Savides T. Severe upper-GI bleeding caused by gastritis cystica profunda. Gastrointest Endosc. 2006; 63:716–717.

13. Koga S, Watanabe H, Enjoji M. Stomal polypoid hyper-trophic gastritis: a polypoid gastric lesion at gastroenterostomy site. Cancer. 1979; 43:647–657.

14. Mitomi H, Iwabuchi K, Amemiya A, Kaneda G, Adachi K, Asao T. Immuno- histochemical and analysis of a case of gastritis cystica profunda associated with carcinoma development. Scand J Gastroenterol. 1998; 33:1226–1229. .1.

15. Park JS, Myung SJ, Jung HY, et al. Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach. Gastrointest Endosc. 2001; 54:101–103. .1.

16. Cho HJ, Kim JE, Jeong BJ, et al. A case of gastric adenocarcinoma arising from gastritis cystica profunda. Korean J Gastrointest Endosc. 2004; 28:237–241.

17. Kim YS, Heo WS, Chae KH, et al. Our experience of gastritis cystica profunda cases and its clinical study. Korean J Gastrointest Endosc. 2006; 33:135–139.