Verrucous gastritis-like lesion in intramucosal Helicobacter pylori-uninfected signet ring cell carcinoma with poorly differentiated adenocarcinoma

TL;DR

This paper reports a rare case of a gastric cancer with a unique elevated lesion in a patient not infected with Helicobacter pylori.

Contribution

The study presents a rare case of intramucosal signet ring cell carcinoma with poorly differentiated adenocarcinoma in an H. pylori-uninfected stomach.

Findings

The case exhibited an elevated, verrucous gastritis-like lesion, which is uncommon in H. pylori-uninfected gastric cancers.

Histopathology revealed dense tumor cell growth and fibrotic reactions in the poorly differentiated adenocarcinoma area.

The patient was successfully treated with endoscopic submucosal dissection.

Abstract

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.

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