Department of Gastroenterology, Hiroshima University Hospital, 1-2-3 Kasumi, Minamiku, Hiroshima, 734-8553, Japan.
Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
Clin J Gastroenterol. 2024 Jun;17(3):412-418. doi: 10.1007/s12328-024-01952-9. Epub 2024 Mar 23.
In Japan, accessible Helicobacter pylori (Hp) eradication therapy is associated with an increase in the prevalence of gastric cancers (GCs) in Hp uninfected stomachs. Signet ring cell carcinoma (SRCC) is the most common of these GCs. Intramucosal SRCC with poorly differentiated adenocarcinoma (PDA) occurring in Hp uninfected gastric mucosa is rare; furthermore, many Hp uninfected pure SRCCs exhibit discoloration and flat or slightly depressed lesions, and morphological elevation is relatively rare. We report a case of intramucosal SRCC with PDA with an elevated, verrucous gastritis-like lesion in a 57-year-old male patient. In the present case, the PDA area showed dense tumor cell growth and coexisting desmoplastic and fibrotic reactions. Histopathology and immunohistochemical staining identified extensive fibromuscular obliteration with smooth muscle bundles extending from the muscularis mucosa into the lamina propria. The patient underwent curative endoscopic submucosal dissection. The reporting and analysis of such rare cases may lead to a better understanding of the characteristics of advanced Hp uninfected GCs.
在日本，可及的幽门螺杆菌（Hp）根除疗法与 Hp 未感染胃中胃癌（GCs）的患病率增加有关。印戒细胞癌（SRCC）是最常见的 GC 之一。在 Hp 未感染的胃黏膜中，黏膜内 SRCC 伴低分化腺癌（PDA）很少见；此外，许多 Hp 未感染的纯 SRCC 表现为变色和扁平或轻度凹陷性病变，形态隆起相对少见。我们报告了一例 57 岁男性患者的黏膜内 SRCC 伴 PDA，表现为隆起的疣状胃炎样病变。在本病例中，PDA 区域显示密集的肿瘤细胞生长，并伴有纤维母性和纤维性反应。组织病理学和免疫组织化学染色显示广泛的纤维肌性闭塞，平滑肌束从黏膜肌层延伸到固有层。患者接受了根治性内镜黏膜下剥离术。对这种罕见病例的报告和分析可能有助于更好地了解晚期 Hp 未感染 GCs 的特征。
