Asian J Surg 2024 Sep 12:S1015-9584(24)02063-3. doi: 10.1016/j.asjsur.2024.08.264
A/S: 77세 여성
C/Cx: Abdominal discomfort에 대한 endoscopy 위해 전원
* Gastroscopy
: Abundant gastric mucus 및 severe atrophy of the gastric body mucosa (Fig. 1A)
: Numerous white raised lesions at the bottom of the stomach (Fig. 1B)
: Antrum - characteristic circular pattern (+), apparent atrophy (-)
: NBI (narrow band image)
- Type II A lesion in the anterior wall of the lower part of the stomach
- Surface of the lesion: dense glandular ducts, slightly thickened blood vessels, & irregular white opaque substances (WOS) (Fig. 1C).
* Pathology
: Bx - Low grade intraepithelial neoplasia with intestinal metaplasia
: post-ESD pathologic results [Oxyntic gland adenoma (OGA) (Fig. 1D)]
- Low grade intraepithelial neoplasia of the glandular epithelium, with atrophic changes in the surrounding mucosa
- Nodule with a diameter of about 2 mm
* Immunohistochemical staining of the nodule
: Ki67 (+, approximately 1 %), synaptophysin (++), MUC6 (++)
* Serology (post-ESD): positive [anti-intrinsic factor & anti-parietal cell antibodies]
Fig. 1. Gastroscopy revealed significant atrophy of the gastric body mucosa (A) and numerous white raised lesions at the bottom of the stomach (B). The surface of the lesion had dense glandular ducts, slightly thickened blood vessels, and irregular white opaque substances (C). A nodule with a diameter of about 2 mm was seen, which was considered to be an oxyntic gland adenoma (D).
Autoimmune atrophic gastritis (AAG) is characterized by the presence of atrophy in the oxyntic mucosa associated with anti-parietal cell antibody, resulting in acid-free and hypergastrinemic. The prevalence of AAG is estimated to range between 0.3 % and 2.7 %. OGA is a relatively benign epithelial neoplasm that comprises chief cells and/or parietal cells with mild nuclear atypia and mainly occurs in the non-atrophic acidic mucosa. In the context of AAG, the co-occurrence of OGA with mucosal dysplasia is very rare. This is the first clinical report on such a case to date. The specific pathogenesis and correlated factors are not well understood, and need to be further studied.
Asian J Surg 2024 Sep 12:S1015-9584(24)02063-3. doi: 10.1016/j.asjsur.2024.08.264
A/S: 77세 여성
C/Cx: Abdominal discomfort에 대한 endoscopy 위해 전원
* Gastroscopy
: Abundant gastric mucus 및 severe atrophy of the gastric body mucosa (Fig. 1A)
: Numerous white raised lesions at the bottom of the stomach (Fig. 1B)
: Antrum - characteristic circular pattern (+), apparent atrophy (-)
: NBI (narrow band image)
- Type II A lesion in the anterior wall of the lower part of the stomach
- Surface of the lesion: dense glandular ducts, slightly thickened blood vessels, & irregular white opaque substances (WOS) (Fig. 1C).
* Pathology
: Bx - Low grade intraepithelial neoplasia with intestinal metaplasia
: post-ESD pathologic results [Oxyntic gland adenoma (OGA) (Fig. 1D)]
- Low grade intraepithelial neoplasia of the glandular epithelium, with atrophic changes in the surrounding mucosa
- Nodule with a diameter of about 2 mm
* Immunohistochemical staining of the nodule
: Ki67 (+, approximately 1 %), synaptophysin (++), MUC6 (++)
* Serology (post-ESD): positive [anti-intrinsic factor & anti-parietal cell antibodies]
Fig. 1. Gastroscopy revealed significant atrophy of the gastric body mucosa (A) and numerous white raised lesions at the bottom of the stomach (B). The surface of the lesion had dense glandular ducts, slightly thickened blood vessels, and irregular white opaque substances (C). A nodule with a diameter of about 2 mm was seen, which was considered to be an oxyntic gland adenoma (D).
Autoimmune atrophic gastritis (AAG) is characterized by the presence of atrophy in the oxyntic mucosa associated with anti-parietal cell antibody, resulting in acid-free and hypergastrinemic. The prevalence of AAG is estimated to range between 0.3 % and 2.7 %. OGA is a relatively benign epithelial neoplasm that comprises chief cells and/or parietal cells with mild nuclear atypia and mainly occurs in the non-atrophic acidic mucosa. In the context of AAG, the co-occurrence of OGA with mucosal dysplasia is very rare. This is the first clinical report on such a case to date. The specific pathogenesis and correlated factors are not well understood, and need to be further studied.