クロダ　ハジメ   Kuroda Hajime   黒田　一    所属   医学部 医学科（附属足立医療センター）    職種   教授
論文種別	症例報告
言語種別	英語
査読の有無	査読あり
表題	Gastric Adenocarcinoma of the Fundic Gland Type: A Case Report.
掲載誌名	正式名：The American journal of case reports 略　 称：Am J Case Rep ISSNコード：19415923/19415923
掲載区分	国外
巻・号・頁	22,pp.e933474
著者・共著者	Kakumoto Akinari†, Kuroda Hajime*, Jamiyan Tsengelmaa, Shimakawa Takeshi, Masunaga Atsuko
発行年月	2021/12/02
概要	BACKGROUND Gastric adenocarcinoma of the fundic gland type (GAFG) is an extremely rare neoplasm that consists of a mixed proliferation of oxyntic and chief cells. Differential diagnosis of GAFG is difficult in the absence of infiltration. Here, we report a case of GAFG and discuss the clinicopathological features. CASE REPORT A 78-year-old man was diagnosed with gastritis and reflux esophagitis, status after esophagectomy for carcinoma of the esophagus in 2015. The patient underwent repeated gastric biopsies in 2017 and an atypical epithelium was observed, but no diagnosis was confirmed. There was no evidence of tumor extension in the submucosa. The tumor was resected via endoscopic mucosal resection, and pathological examination was performed. Microscopic findings revealed an oxyntic-type gastric mucosa with atypical dense or dilated glands with abundant pale basophilic cytoplasm and round nuclei with prominent nucleoli. The majority of the tumor cells resembled chief cells, suggesting they were derived from gastric fundic glands. However, the tumor appeared to have no submucosal infiltration or focal stromal desmoplastic reaction. Sections stained positive for MUC6 and pepsinogen-I in chief cells, and H+/K+ ATPase and PDGFRa in parietal cells, but were mostly negative for CDX2, chromogranin A, synaptophysin, and CD10. Sections stained for mib-1 expressed very low proliferative activity, with an average of 10%. Staining for TP53 overexpression was negative. CONCLUSIONS Immunostaining markers are a supportive tool for histological diagnosis of GAFG. However, if there is no infiltration, as in our case, it is difficult to consider it as a malignant tumor. Further elucidation is needed in the future, including an officially accepted diagnostic name.
DOI	10.12659/AJCR.933474
PMID	34853292