J Can Assoc Gastroenterol. 2023 Nov 27;7(3):219-220. doi: 10.1093/jcag/gwad050.
An 84-year-old female with iron-deficiency anemia underwent upper endoscopy, which revealed diffuse loss of gastric folds and marked vascular appearance (Fig. 1a). Using magnifying Blue-light imaging (M-BLI), the body of the stomach exhibited a groove/tubular pattern consistent with atrophy (Fig. 1b). Additionally, a small white lesion with a globular shape was noted in the atrophic gastric body (Fig. 1b and and1c). The remainder of the upper endoscopy was unremarkable. The diagnosis of AIG was confirmed through histology and immunology, which showed atrophic gastritis and neuroendocrine hyperplasia (Fig. 1d), and positive anti-parietal cell antibodies, respectively. Histology of the white lesion demonstrated a microcyst containing necrotic and proteinaceous debris. This was consistent with what has been termed White Globe appearance (WGA) has been demonstrated to be associated with gastric cancer.
Figure 1. Atrophic gastritis with WGA, (a) Atrophic Gastric Body with loss of gastric folds and marked vascular visibility, (b) Blue light imaging of gastric body with WGA low magnification, (c) Blue light imaging of WGA high magnification, (d) 100× Hematoxylin phloxine saffron (HPS) stain Atrophic Gastritis with intestinal metaplasia and neuroendocrine hyperplasia, (e) HPS stain of microcyst with intraglandular necrotic and proteinaceous debris, (f) Higher magnification HPS stain of microcyst with intraglandular necrotic and proteinaceous debris.
AIG is associated with anemia and is known to increase the risk of gastric cancer. Its recognition relies on the identification of gross findings such as loss of gastric folds, as well as magnifying findings such as oval/slit, tubular, and foveolar patterns.
The finding of WGA in association with AIG has not been previously described in North American literature. Nonetheless, there have been two case reports in Japanese literature. The exact significance of WGA in the context of AIG at this time is unknown. It is speculative that in the context of its association with early gastric cancer, patients with AIG and WGA may perhaps be at an even higher risk of gastric cancer. However, a large series with long-term follow-up would be required to substantiate such speculation.
WGA와 gastric cancer의 관계는 불분명합니다. 아마도 inflmmatory process 과정에서 나타난 intraglandular necrotic debris 정도로 생각하는 게 나을 듯 싶습니다.
J Can Assoc Gastroenterol. 2023 Nov 27;7(3):219-220. doi: 10.1093/jcag/gwad050.
An 84-year-old female with iron-deficiency anemia underwent upper endoscopy, which revealed diffuse loss of gastric folds and marked vascular appearance (Fig. 1a). Using magnifying Blue-light imaging (M-BLI), the body of the stomach exhibited a groove/tubular pattern consistent with atrophy (Fig. 1b). Additionally, a small white lesion with a globular shape was noted in the atrophic gastric body (Fig. 1b and and1c). The remainder of the upper endoscopy was unremarkable. The diagnosis of AIG was confirmed through histology and immunology, which showed atrophic gastritis and neuroendocrine hyperplasia (Fig. 1d), and positive anti-parietal cell antibodies, respectively. Histology of the white lesion demonstrated a microcyst containing necrotic and proteinaceous debris. This was consistent with what has been termed White Globe appearance (WGA) has been demonstrated to be associated with gastric cancer.
Figure 1. Atrophic gastritis with WGA, (a) Atrophic Gastric Body with loss of gastric folds and marked vascular visibility, (b) Blue light imaging of gastric body with WGA low magnification, (c) Blue light imaging of WGA high magnification, (d) 100× Hematoxylin phloxine saffron (HPS) stain Atrophic Gastritis with intestinal metaplasia and neuroendocrine hyperplasia, (e) HPS stain of microcyst with intraglandular necrotic and proteinaceous debris, (f) Higher magnification HPS stain of microcyst with intraglandular necrotic and proteinaceous debris.
AIG is associated with anemia and is known to increase the risk of gastric cancer. Its recognition relies on the identification of gross findings such as loss of gastric folds, as well as magnifying findings such as oval/slit, tubular, and foveolar patterns.
The finding of WGA in association with AIG has not been previously described in North American literature. Nonetheless, there have been two case reports in Japanese literature. The exact significance of WGA in the context of AIG at this time is unknown. It is speculative that in the context of its association with early gastric cancer, patients with AIG and WGA may perhaps be at an even higher risk of gastric cancer. However, a large series with long-term follow-up would be required to substantiate such speculation.
WGA와 gastric cancer의 관계는 불분명합니다. 아마도 inflmmatory process 과정에서 나타난 intraglandular necrotic debris 정도로 생각하는 게 나을 듯 싶습니다.