Post written by Lady Katherine Mejia Perez, MD, and Kyungran Justina Cho, MD, PhD, from the Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Erica Savage, MD, from the Department of Pathology and Laboratory Medicine, Cleveland Clinic, and Amit Bhatt, MD, from the Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic, Cleveland, Ohio, USA.
We describe a unique case of a large well-differentiated gastric adenocarcinoma of fundic-gland type (GA-FG) with submucosal invasion that was successfully resected with endoscopic submucosal dissection (ESD).
This rare type of adenocarcinoma was recently described in Asia and is felt to follow a benign course.1 A few cases have been described in the West, all with small sizes and treated with endoscopic mucosal resection. Our case highlights the importance of considering ESD to achieve curative resection of potentially more aggressive lesions.
GA-FG is a rare subtype of gastric adenocarcinoma, thought to arise from an oxyntic gland adenoma. Despite GA-FG’s perceived benign nature, our case demonstrates a large lesion with submucosal invasion. This features the role of ESD in achieving curative resections when treating GA-FG. Description of further cases is required to understand the pathophysiology and biological behavior.
White-light endoscopic view revealing a 25-mm lesion in the greater curvature of the upper gastric body with Paris classification type 0-IIa+IIc morphology. The mucosal lesion has irregular mucosa with branching dilatated mucosal vessels (black arrows). The adjacent mucosa is nonatrophic (blue arrowheads).
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- Tsukamoto T, Yokoi T, Maruta S, et al. Gastric adenocarcinoma with chief cell differentiation. Pathol Int 2007;57:517-22. ↩︎
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