KURODA Hajime    Department   School of Medicine(Tokyo Women's Medical University Adachi Medical Center), School of Medicine    Position   Professor
Article types	Case report
Language	English
Peer review	Peer reviewed
Title	Gastric Adenocarcinoma of the Fundic Gland Type: A Case Report.
Journal	Formal name：The American journal of case reports Abbreviation：Am J Case Rep ISSN code：19415923/19415923
Domestic / Foregin	Foregin
Volume, Issue, Page	22,pp.e933474
Author and coauthor	Kakumoto Akinari†, Kuroda Hajime*, Jamiyan Tsengelmaa, Shimakawa Takeshi, Masunaga Atsuko
Publication date	2021/12/02
Summary	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