Clinicopathological Features of Gastric Adenocarcinoma of the Fundic Gland (Chief Cell Predominant Type) by Retrospective and Prospective Analyses of Endoscopic Findings

Objectives:

Gastric adenocarcinoma of the fundic gland type (chief cell predominant type) (GA-FG-CCP) is a variant of gastric adenocarcinoma with chief cell differentiation. GA-FG-CCP is rare and has not been well understood. The present study aimed to investigate the clinicopathological features of GA-FG-CCP via retrospective and prospective analyses of endoscopic findings.

Methods

A total of 20 patients including nine cases treated with endoscopic submucosal dissection were diagnosed with GA-FG-CCP. The morphological changes were analyzed by retrospectively retracing past endoscopic records and following up after definitive diagnoses, including the status of Helicobacter pylori (H. pylori) infection.

Results

The GA-FG-CCPs were small and whitish lesions accompanied by atypical vascular growth and their macroscopic types were classified as 0-IIa (60%), 0-IIb (25%), and 0-IIc (15%), respectively. The lesions were found in the non-atrophic gastric mucosa of the upper (70%) or middle portion (30%), although gastric mucosal atrophy associated with current or past H. pylori infection was identified in 75% of cases. In the nine cases treated with endoscopic submucosal dissection, submucosal invasion was identified in 80% of the resected lesions, but no lymphovenous infiltration was detected. Ki-67-LIs of GA-FG-CCP were low at 3.2% and visible morphologic changes were rarely detected during long-term endoscopic observation for 58.9 ± 13.1 months.

Conclusions

These data indicate that GA-FG-CCP, even when submucosal invasion occurs easily, might be of low-grade malignancy as long as it is the chief cell predominant type without other epithelial abnormalities. In addition, GA-FG-CCP might develop despite H. pylori infection or gastric mucosal atrophy.

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