Gastric adenocarcinoma of fundic gland type with signet-ring cell carcinoma component: A case report and review of the literature

World J Gastroenterol. 2018 Jul 14;24(26):2915-2920. doi: 10.3748/wjg.v24.i26.2915.


A depressed lesion was found at a gastric angle of 76-year-old Japanese woman by esophagogastroduodenoscopy. Four years prior, she was diagnosed with a Helicobacter pylori infection but no eradication was performed. The pathological diagnosis of biopsy specimens was signet-ring cell carcinoma. Endoscopic submucosal dissection (ESD) was performed. Histopathological examination of the ESD specimen revealed proliferation of well-differentiated tubular adenocarcinoma mimicking fundic gland cells at the deep layer of the lamina propria mucosae. These tumor cells expressed focally pepsinogen-I, diffusely MUC6, and scattered H+/K+ ATPase according to immunohistochemistry. Therefore, we diagnosed this tumor as gastric adenocarcinoma of fundic gland type (GA-FG). Adjacent to the GA-FG, proliferation of signet-ring cell carcinoma which diffusely expressed MUC 2 and MUC 5AC was observed. Intestinal metaplasia was focally observed in the surrounding mucosa of the signet-ring cell carcinoma. To the best of our knowledge, this is the first case report of GA-FG with a signet-ring cell carcinoma component. The origin of signet-ring cell carcinoma, i.e., whether it accidentally arose from a non-neoplastic mucosa and coexisted with the GA-FG or dedifferentiated from the GA-FG is unclear at present. We expect the accumulation of similar cases and further analysis to clarify this issue.

Keywords: Endoscopic submucosal dissection; Gastric adenocarcinoma of fundic gland type; Helicobacter pylori; Intestinal metaplasia; Signet-ring cell carcinoma.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adenocarcinoma / diagnostic imaging
  • Adenocarcinoma / pathology*
  • Adenocarcinoma / surgery
  • Aged
  • Biopsy
  • Carcinoma, Signet Ring Cell / diagnostic imaging
  • Carcinoma, Signet Ring Cell / pathology*
  • Carcinoma, Signet Ring Cell / surgery
  • Endoscopic Mucosal Resection
  • Female
  • Gastric Fundus / diagnostic imaging
  • Gastric Fundus / microbiology
  • Gastric Fundus / pathology
  • Gastric Fundus / surgery
  • Gastric Mucosa / microbiology
  • Gastric Mucosa / pathology*
  • Gastric Mucosa / surgery
  • Gastroscopy
  • Helicobacter Infections / diagnosis
  • Helicobacter Infections / microbiology
  • Helicobacter Infections / pathology*
  • Helicobacter pylori / isolation & purification
  • Humans
  • Metaplasia / pathology
  • Narrow Band Imaging / methods
  • Stomach Neoplasms / diagnostic imaging
  • Stomach Neoplasms / pathology*
  • Stomach Neoplasms / surgery