Synchronous double superficial mixed gastrointestinal mucus phenotype gastric cancer with gastritis cystica profunda and submucosal lipoma: A case report

Abstract

Introduction: Synchronous double superficial gastric cancer with gastritis cystica profunda (GCP) and submucosal lipoma is a rare disease and is difficult to diagnose and treat.

Case presentation: A 61-year-old man was referred to our hospital with upper abdominal discomfort for the past 10 days. One year ago, the patient underwent surgery for duodenal ulcer and perforation. The diseases were diagnosed by magnifying endoscopy with narrowband imaging and pathological methods. Both mucosal lesions with a submucosal yellow-colored nodule were completely resected by endoscopic submucosal dissection and additional proximal gastrectomy was performed on the cancer embolus in the submucosal vena cava. The patient was finally diagnosed with synchronous double superficial well differentiated adenocarcinoma (mixed gastrointestinal mucus phenotype) with embolus in submucosal vena cava, coexisting with gastritis cystica profunda and submucosal lipoma. Final TNM classification was T1b (sm1) N0M0, and pathological stage was IA. The postoperative course was uneventful, and no recurrence or metastasis was observed during the 5-month follow-up period.

Conclusion: The diagnosis and treatment of synchronous double superficial gastric cancer with GCP and submucosal lipoma is challenging. In addition, elastic fiber staining and immune marker staining is effective and should be considered for diagnosis.

Figure 1

Endoscopic findings. (A) A 5-mm diameter mucosal erosion in the lesser curvature side of the cardia. (B) A 10-mm mucosal irregular depression with marginal nodular elevation in the posterior wall of the gastric body and fundus junction; ME-NBI findings. (C) Local intensive villi change in the lesser curvature side of the cardia. (D) An irregular villous loop pattern in the posterior wall of the gastric body and fundus junction. ME-NBI = magnifying endoscopy with narrow-band imaging.

Figure 2

A yellow-colored nodule beneath the cancerous mucosa in the posterior wall of the gastric body and fundus junction.

Figure 3

Pathological examination of the lesions showed (A) a well-differentiated tubular adenocarcinoma completely involved in the gastritis cystica profunda in the lesser curvature side of the cardia (10 × 10); (B) a well-differentiated tubular adenocarcinoma, locally invading mucosal muscle in the posterior wall of the gastric body and fundus junction (10 × 10). Mapping of the ESD specimen revealed two synchronous superficial well-differentiated tubular adenocarcinomas (C) (a: the lesser curvature side of the cardia, b: the posterior wall of the gastric body and fundus junction). ESD = endoscopic submucosal dissection.

Figure 4

(A) Elastic fiber staining revealed a cancer embolus in a submucosal vena cava (10 × 10); (B) immunohistochemical staining of the tumor tissue showed CDX2 (+); and (C) MUC6 (partial+) (Envision, 10 × 10).