J Gastric Cancer.  2019 Jun;19(2):225-233. 10.5230/jgc.2019.19.e21.

Influence of Helicobacter pylori Infection on Endoscopic Findings of Gastric Adenocarcinoma of the Fundic Gland Type

• Ishibashi
• Fukushima
• Ito T
• Kobayashi
• Tanaka R
• Onizuka R

• KMID: 2449943
• DOI: http://doi.org/10.5230/jgc.2019.19.e21

Abstract

PURPOSE
Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) was first reported as a rare adenocarcinoma found in the normal fundic mucosa. Recent studies have proposed the possibility that GA-FG-CCPs were also generated in the atrophic mucosa after Helicobacter pylori (HP) eradication therapy. However, little is known on the endoscopic findings of GA-FG-CCP generated in the atrophic mucosa due to its extreme rarity.
MATERIALS AND METHODS
A total of 8 patients who underwent endoscopic submucosal resection and were diagnosed with GA-FG-CCP generated in the HP-uninfected mucosa (4 cases, HP-uninfected group) or HP-eradicated atrophic mucosa (4 cases, HP-eradicated group) were retrospectively analyzed, and their endoscopic findings, including magnifying endoscopy with narrow band imaging (M-NBI), and pathological features were compared.
RESULTS
While GA-FG-CCPs in the 2 groups displayed similar macroscopic appearance, M-NBI demonstrated that characteristic microvessels (tapered microvessels like withered branches) were specifically identified in the HP-eradicated group. Pathological investigation revealed that a decreasing number of fundic glands and thinned foveolar epithelium covering tumor ducts were thought to lower the thickness of the covering layer over tumor ducts in the HP-eradicated group. Moreover, dilation of vessels just under the surface of the lesions contributed to the visualization of microvessels by M-NBI.
CONCLUSIONS
The change in background mucosa due to HP infection influenced the thickness of the covering layer over the tumor ducts and M-NBI finding of GA-FG-CCP.

Keyword

Gastric cancer; Helicobacter pylori; Narrow band imaging

MeSH Terms

Adenocarcinoma*
Endoscopy
Epithelium
Helicobacter pylori*
Helicobacter*
Humans
Microvessels
Mucous Membrane
Narrow Band Imaging
Retrospective Studies
Stomach Neoplasms

Figure

• 

  Fig. 1 Representative white light imaging of all cases of gastric adenocarcinoma of the fundic gland type (chief cell predominant type) generated in the HP-uninfected group (A-D) and HP-eradicated group (E-H). HP = Helicobacter pylori.

• 

  Fig. 2 Representative magnifying endoscopy with narrow band imaging of all cases of gastric adenocarcinoma of the fundic gland type (chief cell predominant type) generated in the HP-uninfected group (A-D) and HP-eradicated group (E-H). HP = Helicobacter pylori.

• 

  Fig. 3 (A, B) Representative H&E staining of all cases of GA-FG-CCP generated in the HP-uninfected group (A) and HP-eradicated group (B) showed the difference in the thickness of covering layer over the tumor ducts. (C) There was no significant difference in thickness of the lesions between the HP-uninfected and HP-eradicated groups. (D) The covering layer over the tumor ducts seen in the HP-uninfected group was significantly thicker than that in the HP-eradicated group (350.5±13.1 µm vs. 138±65.7 µm, P<0.05). Data are expressed as mean±standard error of the mean. (D, E) High-magnification view focusing on the surface lesion of H&E staining of all cases of GA-FG-CCP generated in the HP-uninfected group (E) and HP-eradicated group (F) showed the difference in the number of residue of fundic epithelial cells. (G, H) H&E staining focusing on the border of the lesions of GA-FG-CCP generated in the HP-uninfected group (G) and HP-eradicated group (H) showed the difference in thickness of the background mucosa. HP = Helicobacter pylori; H&E = hematoxylin and eosin stain; GA-FG-CCP = gastric adenocarcinoma of the fundic gland type (chief cell predominant type); NS = not significant.

• 

  Fig. 4 (A, B) Representative hematoxylin and eosin stain staining focusing on the surface of the lesion generated in the HP-uninfected group (A) and HP-eradicated group (B). (C) Vessels observed within the covering layer of gastric adenocarcinoma of the fundic gland type (chief cell predominant type) generated in the HP-eradicated group were significantly larger than those in the HP-uninfected group (44.5±9.8 μm vs. 17.0±3.0 μm, P<0.05). Data are expressed as mean±standard error of the mean. HP = Helicobacter pylori.

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