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Case Reports
. 2024 Jun 25;16(6):e63148.
doi: 10.7759/cureus.63148. eCollection 2024 Jun.

Helicobacter pylori-Negative Differentiated Intramucosal Gastric Cancer in the Antrum With a Morphological Change in Four Years: A Case Series

Takashi Obana  1 , Shuuji Yamasaki  1 , Yoshikazu Yakami  1
Affiliations
Case Reports

Helicobacter pylori-Negative Differentiated Intramucosal Gastric Cancer in the Antrum With a Morphological Change in Four Years: A Case Series

Takashi Obana et al. Cureus. .

Abstract

This case report presents two cases of differentiated intramucosal gastric cancer in the antrum. Both patients reported no history of Helicobacter pylori eradication therapy, and endoscopy and diagnostic tests indicated no H. pylori infection. Case 1 is a female patient in her 70s. Esophagoduodenogastroscopy (EGD) detected a depressed lesion. Adenocarcinoma was suspected; thus, endoscopic submucosal dissection (ESD) was performed to resect the lesion. The histological result was well-differentiated tubular adenocarcinoma, which predominantly demonstrated an intestinal mucin phenotype. The existence of a small elevated lesion in the same location was confirmed by reviewing the previous endoscopic record 52 months earlier. Case 2 is a male patient in his 60s in whom screening EGD detected an elevated lesion. The biopsy indicated gastric adenoma, and ESD was performed. The histological diagnosis was well-to-moderately differentiated tubular adenocarcinoma with a pure gastric phenotype. These results indicate that H. pylori-negative differentiated gastric carcinomas in the antrum occur as small elevated lesions that may gradually progress to a depressed form during a relatively long clinical course.

Keywords: gastric cancer; helicobacter pylori-negative; intestinal type; morphological change; natural course.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Endoscopic image of Case 1
Esophagoduodenogastroscopy (EGD) detected a depressed lesion on the greater curvature of the gastric antrum.
Figure 2
Figure 2. Narrow-band imaging (NBI) findings of the lesion
a. Magnifying endoscopy with narrow-band imaging (ME-NBI) shows an irregular microsurface pattern in the depressed area. b. A slightly irregular microvascular pattern was also observed.
Figure 3
Figure 3. Resected specimen
a. The resected specimen was cut into 12 slices. b. In slice 7, neoplastic cells were present in the denoted area (hematoxylin-eosin (HE) staining).
Figure 4
Figure 4. Histopathological images
a. The high-power field of slice 7 reveals the existence of well-differentiated tubular adenocarcinoma (hematoxylin and eosin (HE) ×100). b-e. Immunohistochemical staining exhibiting positive CD10 (b) and MUC2 (c) expression. MUC5AC was partially stained (d), and MUC6 was not stained (e),  indicating a predominantly intestinal phenotype (×100).
Figure 5
Figure 5. Endoscopic images of the lesion 52 months earlier
a. Reviewing the previous endoscopic record 52 months earlier revealed the existence of a small elevated lesion in the same location. b. A closer view of the lesion.
Figure 6
Figure 6. Endoscopic images of Case 2
a. Esophagoduodenogastroscopy (EGD) showing an elevated lesion in the antrum. The morphology and location of the lesion were quite similar to those in Figure 5. b.  A closer view of the lesion.
Figure 7
Figure 7. Narrow-band imaging (NBI) findings
Magnifying endoscopy with narrow-band imaging (ME-NBI) shows an irregular microsurface pattern. The irregularity of the microvascular pattern was not confirmed.
Figure 8
Figure 8. Resected specimen
a. The resected specimen was cut into 14 slices. b. In slice 8, adenocarcinoma cells were present in the denoted area (hematoxylin and eosin (HE) staining).
Figure 9
Figure 9. Histopathological images
a. The high-power field of slice 8 reveals a well-to-moderately differentiated tubular adenocarcinoma (hematoxylin and eosin (HE) ×100). b-e. Immunohistochemical staining exhibiting negative CD10 (b) and MUC2 (c) expression. By contrast, MUC5AC (d) and MUC6 (e) were positively stained, indicating a pure gastric phenotype (×100).
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