Gastritis Cystica Profunda: A Rare Disease, a Challenging Diagnosis, and an Uncertain Malignant Potential: A Case Report and Review of the Literature

Abstract

Gastritis cystica profunda (GCP) has been defined as a rare submucosal benign gastric lesion with cystic gland growth. Due to its unclear etiopathogenesis, this lesion is often misdiagnosed and mistaken for other gastric masses. Currently, a standardized treatment for GCP lesions is still missing. Here, we illustrate a case of a patient admitted to our general surgery department for melena and general discomfort. No history of peptic ulcer or gastric surgery was present. Upper GI endoscopy was performed, showing a distal gastric lesion with a small ulceration on the top. CT-scan and endoscopic ultrasound confirmed the presence of the lesion, compatible with a gastric stromal tumor, without showing any eventual metastasis. Surgical gastric resection was performed. Histological findings were diagnostic for GCP, with cistically ectasic submucosal glands, chronic inflammation, eosinophilic infiltration and foveal hyperplasia. GCP is a very exceptional cause of upper-GI bleeding with specific histological features. Its diagnosis as well as its therapy are challenging, resulting in several pitfalls. Even though it is a rare entity, GCP should always be considered in the differential diagnosis of gastric submucosal lesions.

Keywords: ectopic gastric glands; endoscopic ultrasound; gastric submucosal lesion; gastric surgery; gastritis cystica profunda.

Figure 1

Upper GI endoscopy showing a 25 mm submucosal lesion at the posterior wall of the antrum covered with normal mucosa.

Figure 2

Upper GI endoscopy showing ulceration of the submucosal antral lesion without signs of active bleeding.

Figure 3

Contrast enhanced computed tomography (CE-CT) showing a 5 × 2 cm lesion of the antrum, with irregular margins. The yellow arrow indicates the lesion evident in the late arterial phase of the CE-CT.

Figure 4

Endoscopic ultrasound showing submucosal heterogeneous echoic mass with multiloculated cystic spaces (yellow arrow).

Figure 5

Endoscopic ultrasound after Sonovue^TM administration, only the septa of the multiloculated cystic lesion were hyperechoic (yellow arrow) while the holes remained anechoic.

Figure 6

(A–C) Hematoxylin and eosin staining of the specimen, showing many cystically dilated glands in the submucosa and focally in the muscolaris propriae.

Figure 7

Microscopic examination with hematoxylin and eosin staining, showing chronic inflammation and eosinophilic infiltration in the mucosa.