Minute Gastric Adenocarcinoma of the Fundic-Gland Type with Submucosal Invasion

A 64-year-old woman without Helicobacter pylori infection underwent an esophagogastroduodenoscopy during a health examination. A 2-mm flat lesion (0-IIb) with faded color and harboring a regular arrangement of collecting venules was detected at the greater curvature of the gastric fundus. Narrow-band imaging (NBI) showed a distinct whitish lesion. Magnifying endoscopy with NBI revealed a regular microsurface and microvascular pattern without a demarcation line, and a noncancer diagnosis was made [1]. However, as the endoscopic features on white-light imaging still strongly suggested neoplastic lesion in the background of mucosa not infected by H. pylori, a biopsy was taken. Histologically, a gastric adenocarcinoma resembling fundic gland cells with submucosal invasion was seen ([Fig. 1]). A pathological diagnosis of gastric adenocarcinoma of the fundic-gland type [2] [3] was further confirmed by immunohistochemical staining.