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Kim, Jang, Hwang, Ha, Choi, Park, and Han: A Ten-year Follow-up of a Case with Gastric Adenoma Accompanied with Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 59(5): 366-371.

Published online: 21 May 2012

DOI: https://doi.org/10.4166/kjg.2012.59.5.366

A Ten-year Follow-up of a Case with Gastric Adenoma Accompanied with Gastritis Cystica Profunda Treated by Endoscopic Submucosal Dissection

Jung Hee Kim, Sung Yeol Jang, Jeong Ah Hwang, Sung Hae Ha, Won Gyu Choi, Ju Sang Park, Eun Mee Han1

Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea.

1Department of Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea.

Correspondence to: Ju Sang Park, Department of Internal Medicine, Bundang Jesaeng General Hospital, 255-2 Seohyeon-dong, Bundang-gu, Seongnam 463-774, Korea. Tel: +82-31-779-0209, Fax: +82-31-779-0975, parkjs@dmc.or.kr

Received 22 September 2011       Revised 12 December 2011       Accepted 12 December 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastritis cystica profunda (GCP) is an uncommon hyperplastic benign lesion, and histologically characterized by hyperplasia and cystic dilatation of the gastric glands extending into the submucosal layer. GCP usually occurs at a gastroenterostomy site, although it can occasionally be found in an unoperated stomach. GCP is thought to be a possible precancerous lesion, since a few early gastric cancers associated with it were reported. Herein, we report a case of gastric adenoma associated with GCP in an unoperated patient. The sizes of both the GCP and adenoma overlying it have increased during a 10 year follow-up period. Adenoma on the latest biopsy showed low grade dysplasia, and it was successfully treated by endoscopic submucosal dissection.

Keywords: Gastritis cystica profunda, Gastric adenoma, Endoscopic submucosal dissection

Figures and Tables

Fig. 1
(A) Stomach CT finding (3 years ago). It showed an about 3×2.7 cm sized relatively well-defined low density cystic mass (arrow) in the submucosal layer with partly enhanced mucosal portion at the lesser curvature side of the low body. (B) Endoscopic ultrasonography findings. A multiseptated homogenous anechoic lesion (arrow) originating from the third layer accompanied focal wall thickening (arrow head) of the first layer.
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Fig. 2
Endoscopic images. (A) Endoscopy showed an about 3 cm sized slight translucent submucosal tumor accompanied with whitish geographic mucosal lesion on its surface at the lesser curvature side of the lower body (3 years ago). (B) It showed an 4 cm sized submucosal tumor at the same site, but the mucosal lesion has extended (current). (C) Marking. Circumferential marking were made at several points at least 2 mm apart from the outline of mucosal adenomatous lesion by APC within the margin of gastritis cystica profunda (solid line). (D) Submucosal injection and marginal incision. After submucosal injection with Unylone® to help lift the mucosal lesion, marginal incision was done around the lesion using an IT knife 2. Fibrous septum (arrow) and cystic lesion (arrow head) of gastritis cystica profunda were shown after the incision. (E) Submucosal dissection. It showed cystic lesion of remaining gastritis cystica profunda during the dissection. (F) Remaining deep layer of normal submucosa (arrow) and cystic lesion (arrow head) were shown during dissection. (G) Remaining cystic lesion of gastritis cystica profunda after dissection. (H) Partialy resected submucosal cystic lesion with fibrous septal structure (arrow). (I) A post-endoscopic submucosal dissection (ESD) active ulcer without remnant cystic lesion (the day after ESD). (J) A post-ESD ulcer scar without remnant cystic lesion or recurrence of adenoma (6 months later after ESD).
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Fig. 3
(A) Gross finding. The endoscopic submucosal dissection (ESD) specimen measured 3.2×2.5×0.3 cm. It contained an elevated nodular lesion. (B) Microscopic finding. The ESD specimen showed many cystic glands lined by flattend epithelium within the mucosa and low grade tubular adenoma in the surface (H&E, ×40). (C) A low grade tubular adenoma was found and the mucosa showed cystic dilatation of gastric glands (H&E, ×100).
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Table 1
Clinical Characteristics of Gastric Tumor Accompanied with GCP in Unoperated Korean Patients
kjg-59-366-i001

GCP, gastritis cystica profunda; M, male; F, female; GC, greater curvature; LC, lesser curvature; AW, anterior wall; PW, posterior wall; SMT, submucosal tumor; EGC, early gastric cancer; TA, tubular adenoma; HGD, high grade dysplasia; LGD, low grade dysplasia; ESD, endoscopic submucosal dissection.

Notes

Financial support: None.

Conflict of interest: None.

References

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