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Sreeram A, Stroobant EE, Laszkowska M, Guilford P, Shimada S, Nishimura M, Shah S, Vardhana S, Tang LH, Strong VE. Disappearing Signet Ring Cell Adenocarcinoma in Gastric Cancer Patients. Ann Surg Oncol 2024; 31:9030-9038. [PMID: 39343820 DOI: 10.1245/s10434-024-16117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND The incidence of diffuse-type gastric cancer is increasing steadily in the United States, Europe, and Asia. This subtype is known for aggressive clinical characteristics and transmural invasion. However, T1a diffuse-type cancers have been observed to have a better 5-year, disease-specific mortality than stage-matched intestinal tumors, supporting a clinical difference in these early-stage cancers. METHODS Data on all living patients with T1a gastric adenocarcinoma with a finding of signet ring cell morphology on pathology and ≥1 year of follow-up from 2013 to 2023 at Memorial Sloan Kettering Cancer Center (MSK) was collected from a prospectively maintained database. Patients with known CDH1 or CTNNA1 mutations were excluded. RESULTS In 7 of 30 patients, sporadic pathologically confirmed T1a signet ring cell (diffuse) cancer identified on initial biopsy was no longer detectable upon subsequent biopsy or resection with mean follow-up of 50 months. CONCLUSIONS These cases allude to the distinct pathways of carcinogenesis in T1a signet ring cell cancers. Potential factors that may underlie the spontaneous regression of these T1a cancers include complete removal at initial biopsy, immune clearance, and lack of survival advantage conferred by signet ring cell genetic alterations in these cases. Given their more indolent behavior at an earlier stage, we suggest that these lesions can be closely followed by endoscopy in select circumstances with thorough disease assessment and an experienced care team.
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Affiliation(s)
- Aravind Sreeram
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emily E Stroobant
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monika Laszkowska
- Department of Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Parry Guilford
- Department of Biochemistry, Cancer Genetics Laboratory, Centre for Translational Cancer Research (Te Aho Matatu), University of Otago, Dunedin, New Zealand
| | - Shoji Shimada
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Makoto Nishimura
- Department of Medicine, Gastroenterology, Hepatology, and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sohrab Shah
- Computational Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Santosha Vardhana
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura H Tang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Yoshida K, Mikami T, Oyama T, Sato Y, Saito T, Mikami T, Itabashi C, Soma Y, Fukuda S. Signet-ring Cell Carcinoma in Hyperplastic Polyp of the Stomach. Intern Med 2019; 58:3531-3535. [PMID: 31462587 PMCID: PMC6949455 DOI: 10.2169/internalmedicine.2860-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Signet-ring cell carcinoma rarely occurs in gastric hyperplastic polyps, with only a few such cases reported. We treated a 76-year-old woman with a signet-ring cell carcinoma arising from a hyperplastic polyp. She had been diagnosed with a gastric hyperplastic polyp four years previously. A follow-up endoscopic examination revealed the lesion in the polyp. A biopsy showed signet-ring cell carcinoma. Hybrid endoscopic submucosal dissection with snaring and a histological examination revealed signet-ring cell carcinoma in a hyperplastic polyp. The polyp was completely excised, with no evidence of recurrence one year later. A hyperplastic polyp of the stomach may transform into adenocarcinoma of an undifferentiated type.
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Affiliation(s)
- Kenta Yoshida
- Department of Internal Medicine, Kuroishi General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Japan
| | - Takao Oyama
- Department of Internal Medicine, Kuroishi General Hospital, Japan
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Japan
| | - Yuki Sato
- Department of Internal Medicine, Kuroishi General Hospital, Japan
| | - Taro Saito
- Department of Internal Medicine, Kuroishi General Hospital, Japan
| | - Takafumi Mikami
- Department of Internal Medicine, Kuroishi General Hospital, Japan
| | | | - Yasushi Soma
- Department of Internal Medicine, Kuroishi General Hospital, Japan
| | - Shinsaku Fukuda
- Department of Internal Medicine, Kuroishi General Hospital, Japan
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Han SE, Chang J, Paik SS, Kim YJ. Incidentally Discovered Solitary Gastrointestinal Polyp with Pathological Significance in Children: Four Case Reports. Pediatr Gastroenterol Hepatol Nutr 2018; 21:209-213. [PMID: 29992122 PMCID: PMC6037803 DOI: 10.5223/pghn.2018.21.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/11/2017] [Accepted: 01/05/2018] [Indexed: 11/14/2022] Open
Abstract
Most solitary gastrointestinal (GI) polyps in children are either inflammatory or hamartomatous. Solitary hyperplastic polyp, sentinel polyp and solitary adenomatous polyp have been occasionally diagnosed in adults, but very rarely reported in Korean children. We recently came across a case with adenomatous polyp in the colon, a case with hyperplastic polyp beneath the gastroesophageal junction, a case with hyperplastic polyp in the prepyloric area, and a case with sentinel polyp in the distal esophagus, which are unusual pathologic types in children. These mucosal lesions were diagnosed incidentally during elective endoscopic examinations for GI symptoms. Most polyps do not cause significant symptoms, so the diagnosis might be delayed, especially in children, in whom GI endoscopy is not commonly performed for screening purpose as in the adults.
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Affiliation(s)
- Sang-Eun Han
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Jiyeon Chang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Sam Paik
- Department of Pathology, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Joo Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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Kawaguchi S, Yoshimura T, Sakuraba H, Asari T, Sawada Y, Araki Y, Kikuchi K, Wada T, Kusumi T, Fukuda S. Vimentin-positive gastric adenocarcinoma arising in a hyperplastic polyp. Clin J Gastroenterol 2018; 11:245-250. [PMID: 29417386 DOI: 10.1007/s12328-018-0828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/30/2018] [Indexed: 11/27/2022]
Abstract
We report a case of vimentin-positive early gastric adenocarcinoma arising in a hyperplastic polyp (HP). A 72-year-old Japanese man was admitted for the detailed examination of a gastric polyp. He had a subtotal gastrectomy due to acute abdomen 12 years ago. Upper endoscopy revealed a pedunculated polyp measuring approximately 2 cm on the greater curvature of upper body of the remnant stomach. Magnifying endoscopy revealed that the microsurface pattern was irregular and partially absent accompanied with irregular microvessels at the upper end of the polyp. We speculated that the lesion was an adenocarcinoma arising in the HP. Endoscopic submucosal dissection (ESD) was performed. Histological examination of the ESD specimen revealed that the lesion consisted of well- to poorly differentiated adenocarcinoma at the protruding lesion and foveolar hyperplastic epithelia at the base of the polyp. Immunohistochemically, most of tumor cells that comprised poorly-differentiated adenocarcinoma were positive for both cytokeratin and vimentin. Although carcinomas have occasionally been found in HPs, the histological features of the present case are considered extremely unusual. To the best of our knowledge, this is the first case of vimentin-positive early gastric carcinoma arising in a HP.
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Affiliation(s)
- Shogo Kawaguchi
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan.
| | - Tetsuro Yoshimura
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
- Department of Gastroenterology, Aomori City Hospital, Aomori, Japan
| | - Hirotake Sakuraba
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Taka Asari
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yohei Sawada
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
| | - Yasumitsu Araki
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
- Department of Gastroenterology, Aomori City Hospital, Aomori, Japan
| | - Koji Kikuchi
- Department of Gastroenterology, Aomori City Hospital, Aomori, Japan
| | - Toyohito Wada
- Department of Gastroenterology, Aomori City Hospital, Aomori, Japan
| | - Tomomi Kusumi
- Department of Pathology, Aomori City Hospital, Aomori, Japan
| | - Shinsaku Fukuda
- Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan
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Yamanaka K, Miyatani H, Yoshida Y, Ishii T, Asabe S, Takada O, Nokubi M, Mashima H. Malignant transformation of a gastric hyperplastic polyp in a context of Helicobacter pylori-negative autoimmune gastritis: a case report. BMC Gastroenterol 2016; 16:130. [PMID: 27729029 PMCID: PMC5059938 DOI: 10.1186/s12876-016-0537-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/29/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Gastric foveolar hyperplastic polyps (GFHPs) are common findings in clinical practice. GFHPs commonly arise in a background of chronic atrophic gastritis, including autoimmune gastritis (type A gastritis), and have a potential risk of malignant transformation. CASE PRESENTATION In 2005, a 55-year-old Japanese woman underwent upper endoscopy at another hospital and was found to have a pedunculated polyp (10 mm in diameter) on the greater curvature of the lower gastric body. On biopsy, the polyp was diagnosed as a GFHP. Nine years later, the polyp had grown to 20 mm in diameter, and the biopsy specimen taken at this time showed tubular adenocarcinoma. On admission to our hospital, the serum Helicobacter Pylori (H. pylori) immunoglobulin G antibody and stool H. pylori antigen were both negative. Anti-gastric parietal cell antibody was positive, as was the anti-intrinsic factor antibody, and the fasting serum gastrin level was markedly increased. In 2014, en bloc resection of the pedunculated polyp was performed by endoscopic submucosal dissection. The final histological diagnosis was adenocarcinoma of the stomach with submucosal and lymphatic invasion. Subsequently, additional radical distal gastrectomy was performed. At the latest follow-up (12 months postoperatively), no recurrence was noted. CONCLUSIONS We here reported a rare case of malignant transformation of GFHP arising in a context of type A gastritis. To our knowledge, there are no previous reports on malignant transformation of GFHP with submucosal and lymphatic invasion arising in a background of type A gastritis in the English literature. Further, there is currently no effective treatment other than endoscopic or surgical treatment for such cases. Given the potential risk of malignant transformation due to hypergastrinemia, we consider that endoscopic treatment should be considered as a first-line therapy when a malignant growth is suspected.
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Affiliation(s)
- Kenichi Yamanaka
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan.
| | - Hiroyuki Miyatani
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Yukio Yoshida
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Takehiro Ishii
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Shinichi Asabe
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Osamu Takada
- Department of Surgery, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Mitsuhiro Nokubi
- Department of Pathology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Jichi Medical University, Saitama Medical Center, Saitama, 330-8503, Japan
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Song MY, Li J, Jiao YF. An overview of current research of gastric hyperplastic polyps. Shijie Huaren Xiaohua Zazhi 2013; 21:1090-1095. [DOI: 10.11569/wcjd.v21.i12.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastric hyperplastic polyp (GHP) is one of the most common polypoid lesions of the stomach and has the potential of malignant transformation. This article gives a review of recent progress in research of GHP in terms of clinical and pathological factors, pathogenesis, relation with atypical hyperplasia and canceration, molecular biology and mucin expression.
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Kim HS, Hwang EJ, Jang JY, Lee J, Kim YW. Multifocal Adenocarcinomas Arising within a Gastric Inverted Hyperplastic Polyp. KOREAN JOURNAL OF PATHOLOGY 2012; 46:387-91. [PMID: 23110034 PMCID: PMC3479828 DOI: 10.4132/koreanjpathol.2012.46.4.387] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/26/2011] [Indexed: 12/22/2022]
Abstract
We present herein the occurrence of multifocal adenocarcinomas with a minute signet ring cell carcinoma that arose within a gastric inverted hyperplastic polyp (IHP) in a 40-year-old woman. Endoscopic ultrasonography demonstrated a heterogeneous hypoechoic mass in the third layer of the gastric wall. The endoscopic submucosal dissection specimen measuring 3.5×3.2×1.8 cm was a well-circumscribed protruding lesion that had a slit-shaped cavity. Histologically, the lesion consisted mainly of endophytic proliferation of hyperplastic columnar cells resembling normal foveolar epithelium. In addition, six foci of adenocarcinomas and a minute focus of signet ring cell carcinoma were randomly distributed in the superficial and deep regions. The adenocarcinoma was gradually transitioning from dysplasia, while the signet ring cell carcinoma was surrounded by hyperplastic foveolar epithelium. This is the first report of a gastric IHP with multifocal intramucosal adenocarcinomas and a signet ring cell carcinoma, and endoscopic submucosal dissection is used to completely resect it.
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Affiliation(s)
- Hyun-Soo Kim
- Aerospace Medical Research Center, Aerospace Medical Center, Republic of Korea Air Force, Cheongwon, Korea
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Parikh M, Kelley B, Rendon G, Abraham B. Intermittent gastric outlet obstruction caused by a prolapsing antral gastric polyp. World J Gastrointest Oncol 2010; 2:242-6. [PMID: 21160624 PMCID: PMC2998838 DOI: 10.4251/wjgo.v2.i5.242] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 11/30/2009] [Accepted: 12/07/2009] [Indexed: 02/05/2023] Open
Abstract
Most gastric polyps have an asymptomatic presentation and are an incidental finding on upper endoscopy. Symptomatic presentations can range from an ulcerated polyp leading to anemia and occult bleed to complete gastric outlet obstruction. We report a case of an 89-year-old woman who presented with postprandial nausea and early satiety. Her upper endoscopy revealed a 2 cm pedunculated hyperplastic polyp arising from the antrum of the stomach which was seen prolapsing into the pylorus causing intermittent gastric outlet obstruction. In the present report, we statistically analyzed 39 prolapsing gastric polyps previously reported in the English literature and demonstrate the current utility of monopolar snare polypectomy in establishing a histological diagnosis while offering simultaneous treatment. Additionally, we review the literature for the management of all hyperplastic gastric polyps in relation to advancements in digestive endoscopy.
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Affiliation(s)
- Mehul Parikh
- Mehul Parikh, Brian Kelley, Gabriel Rendon, Bincy Abraham, Department of Internal Medicine, Baylor College of Medicine, Houston, TX 77030, United States
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Hirasaki S, Kanzaki H, Fujita K, Matsumura S, Matsumoto E, Yumoto E, Suzuki S. Papillary adenocarcinoma occurring in a gastric hyperplastic polyp observed by magnifying endoscopy and treated with endoscopic mucosal resection. Intern Med 2008; 47:949-52. [PMID: 18480580 DOI: 10.2169/internalmedicine.47.0833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The patient was a 75-year-old man. He had been diagnosed with gastric hyperplastic polyp 4 years previously. The color of the apex of this polyp was whitish. Magnifying endoscopy findings revealed disappearance of the mucosal microstructure with irregular branched capillaries at the top of the polyp. Endoscopic mucosal resection (EMR) was performed. Histological examination revealed that a part of the polyp surface was replaced with papillary adenocarcinoma. Diagnosis of papillary adenocarcinoma in a hyperplastic polyp with mucosal invasion was made. Magnifying endoscopy was useful for the detection of gastric cancer occurring in the hyperplastic polyp in the present case.
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Affiliation(s)
- Shoji Hirasaki
- The Second Department of Internal Medicine, Sumitomo Besshi Hospital, Niihama.
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Hirasaki S, Suzuki S, Kanzaki H, Fujita K, Matsumura S, Matsumoto E. Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp. World J Gastroenterol 2007; 13:5779-80. [PMID: 17963309 PMCID: PMC4171269 DOI: 10.3748/wjg.v13.i43.5779] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection (EMR) was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.
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