J Gastric Cancer.  2018 Dec;18(4):409-416. 10.5230/jgc.2018.18.e22.

Gastric Adenocarcinoma of Fundic Gland Type with Aggressive Transformation and Lymph Node Metastasis: a Case Report

• Okumura Y
• Takamatsu
• Ohashi M
• Yamamoto Y
• Yamamoto N
• Kawachi H
• Ida S
• Kumagai K
• Nunobe S
• Hiki N
• Sano T

• KMID: 2429887
• DOI: http://doi.org/10.5230/jgc.2018.18.e22

Abstract

A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.

Keyword

Gastric gland; Lymph nodes; Neoplasm metastasis

MeSH Terms

Adenocarcinoma*
Biopsy
Endoscopy
Endosonography
Gastrectomy
Gastric Mucosa
Humans
Lymph Node Excision
Lymph Nodes*
Middle Aged
Mucous Membrane
Neoplasm Metastasis*

Figure

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  Fig. 1 (A) Gastroscopy findings at the medical check-up during which the tumor was originally detected. (B) Gastroscopy findings 10 years later showing an enlarged submucosal tumor with evident morphological changes (arrows).

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  Fig. 2 (A) The resected specimen consists of a locally thickened mass 4.7 cm in diameter located in the posterior wall of the upper gastric body. (B) The lesion borders are indistinct (arrows).

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  Fig. 3 Representative photomicrographs of gastric adenocarcinoma of the fundic gland type (GA-FG). (A) Low-power image of the tumor. In the top row, four lesions are indicated by squares and labeled B, C, D, and E; these correspond with the images in the bottom row (scale bar: 1 mm). (B) Mucosal and (C) submucosal tumor cells with round nuclei and predominantly basophilic cytoplasm. A few intermingled cells have eosinophilic cytoplasm. (D) Irregularly shaped glands with occasional anastomoses (left) that gradually transition into isolated dilated tubular glands (right). (E) Infiltrative component in the muscular layer. The inset shows neural invasion. (F) Cancer glands exhibiting venous invasion (arrowheads) confirmed by Elastica van Gieson staining. (G) Metastasis in a lymph node (arrowheads). The inset clearly demonstrates the cancer glands. Scale bars of the main images: 100 µm (scale bars of the insets: 50 µm for E, G and 20 µm for F).

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  Fig. 4 Immunohistochemically stained photomicrographs of cancer components in the mucosa (A-F) and subserosa (G-L). The tumor sections were stained for MUC5AC (B, H), MUC6 (C, I), H+/K+ ATP-ase (D, J), pepsin A (E, K), and Ki-67 (F, L) (scale bars: 50 µm).

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