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CA19-9-producing early gastric adenocarcinoma arising in hyperplastic foveolar polyp: a very unique resection case.

Guo X, Yamada S, Omori H, Wang KY, Tasaki T, Nabeshima A, Kohno K, Sasaguri Y - Diagn Pathol (2011)

Bottom Line: A solitary pedunculated polyp lesion of the stomach, measuring 26 × 20 × 20 mm, was noticed in a 76-year-old Japanese woman due to an abdominal disorder, associated with a markedly high serum CA19-9 level (2,172.6 U/ml).No stromal invasion was evident.Immunohistochemically, distinct nuclear stainings for p53 and Ki-67 were seen, occasionally conforming to the CA19-9-positive atypical cells, respectively, confirmed by double immunostaining.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Cell Biology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.

ABSTRACT
Here we report the first case of carbohydrate antigen (CA) 19-9-producing early gastric adenocarcinoma arising in polyp. A solitary pedunculated polyp lesion of the stomach, measuring 26 × 20 × 20 mm, was noticed in a 76-year-old Japanese woman due to an abdominal disorder, associated with a markedly high serum CA19-9 level (2,172.6 U/ml). After endoscopic mucosal resection was performed, the CA19-9 level was drastically decreased and normalized. The scanning view of immunohistochemical staining of CA19-9 exhibited a focal, not diffuse, positive-expression in the hyperplastic epithelium and, especially, in the irregular and fused tubular glands and the mucinous material secreted into the dilated glands. In particular, microscopic examination of the strongly CA19-9-positive areas showed structurally atypical epithelium containing mildly to focal moderately enlarged nuclei and prominent nucleoli with loss of cellular polarity, estimated as adenocarcinoma. No stromal invasion was evident. Immunohistochemically, distinct nuclear stainings for p53 and Ki-67 were seen, occasionally conforming to the CA19-9-positive atypical cells, respectively, confirmed by double immunostaining. These hyperplastic and atypical cells were classified into the pure gastric phenotype by mucin histochemical methods. Based on these features, we finally made a conclusive diagnosis of CA19-9-producing in situ well differentiated adenocarcinoma of gastric type arising in hyperplastic foveolar polyp. We suggest that the markedly high serum CA 19-9 level could be indicative of carcinoma in polyp at the very least.

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Related in: MedlinePlus

Endoscopic and gross examination of the polyp. Gastrointestinal endoscopy shows a solitary pedunculated polyp lesion, classified as Yamada type IV, in the posterior wall of lower gastric body. On gross finding of the resected specimen (inset), the surface of this polyp, measuring 26 × 20 × 20 mm, reveals focally irregular features with erosion and hemorrhage.
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Figure 1: Endoscopic and gross examination of the polyp. Gastrointestinal endoscopy shows a solitary pedunculated polyp lesion, classified as Yamada type IV, in the posterior wall of lower gastric body. On gross finding of the resected specimen (inset), the surface of this polyp, measuring 26 × 20 × 20 mm, reveals focally irregular features with erosion and hemorrhage.

Mentions: The patient was a 76-year-old woman, who had only hypertension with long-term administration of depressors in her past medical history. She had never taken Sucralfate, a drug for protection against gastric mucosa. She complained about abdominal disorder at the rt. lower portion, but nothing remarkable was found in her laboratory data except for a markedly high serum CA19-9 level (2,172.6 U/ml, normal ranges: < 37 U/ml) by electrochemiluminescence detection method for development of immunoassays (ECLIA; BECKMAN COULTER, Tokyo, Japan). The other tumor markers, such as carcino-embryonic antigen (CEA) or CA125, were within normal limits. No remarkable change was seen in the abdominal and chest CT. Gastrointestinal endoscopy was performed for further investigation, revealing a solitary pedunculated polyp lesion measuring approximately 25 mm in the posterior wall of the lower gastric body (Figure 1). It was estimated as type IV according to Yamada's classification [7]. Eleven days after endoscopic mucosal resection, the CA19-9 level was drastically decreased (136.4 U/ml). Moreover, it was down to 60 U/ml 1 day after appendectomy due to acute appendicitis (13 days after the resection), and was within the normal limit 1 year later. The patient is alive and well without recurrence.


CA19-9-producing early gastric adenocarcinoma arising in hyperplastic foveolar polyp: a very unique resection case.

Guo X, Yamada S, Omori H, Wang KY, Tasaki T, Nabeshima A, Kohno K, Sasaguri Y - Diagn Pathol (2011)

Endoscopic and gross examination of the polyp. Gastrointestinal endoscopy shows a solitary pedunculated polyp lesion, classified as Yamada type IV, in the posterior wall of lower gastric body. On gross finding of the resected specimen (inset), the surface of this polyp, measuring 26 × 20 × 20 mm, reveals focally irregular features with erosion and hemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3285093&req=5

Figure 1: Endoscopic and gross examination of the polyp. Gastrointestinal endoscopy shows a solitary pedunculated polyp lesion, classified as Yamada type IV, in the posterior wall of lower gastric body. On gross finding of the resected specimen (inset), the surface of this polyp, measuring 26 × 20 × 20 mm, reveals focally irregular features with erosion and hemorrhage.
Mentions: The patient was a 76-year-old woman, who had only hypertension with long-term administration of depressors in her past medical history. She had never taken Sucralfate, a drug for protection against gastric mucosa. She complained about abdominal disorder at the rt. lower portion, but nothing remarkable was found in her laboratory data except for a markedly high serum CA19-9 level (2,172.6 U/ml, normal ranges: < 37 U/ml) by electrochemiluminescence detection method for development of immunoassays (ECLIA; BECKMAN COULTER, Tokyo, Japan). The other tumor markers, such as carcino-embryonic antigen (CEA) or CA125, were within normal limits. No remarkable change was seen in the abdominal and chest CT. Gastrointestinal endoscopy was performed for further investigation, revealing a solitary pedunculated polyp lesion measuring approximately 25 mm in the posterior wall of the lower gastric body (Figure 1). It was estimated as type IV according to Yamada's classification [7]. Eleven days after endoscopic mucosal resection, the CA19-9 level was drastically decreased (136.4 U/ml). Moreover, it was down to 60 U/ml 1 day after appendectomy due to acute appendicitis (13 days after the resection), and was within the normal limit 1 year later. The patient is alive and well without recurrence.

Bottom Line: A solitary pedunculated polyp lesion of the stomach, measuring 26 × 20 × 20 mm, was noticed in a 76-year-old Japanese woman due to an abdominal disorder, associated with a markedly high serum CA19-9 level (2,172.6 U/ml).No stromal invasion was evident.Immunohistochemically, distinct nuclear stainings for p53 and Ki-67 were seen, occasionally conforming to the CA19-9-positive atypical cells, respectively, confirmed by double immunostaining.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Cell Biology, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan.

ABSTRACT
Here we report the first case of carbohydrate antigen (CA) 19-9-producing early gastric adenocarcinoma arising in polyp. A solitary pedunculated polyp lesion of the stomach, measuring 26 × 20 × 20 mm, was noticed in a 76-year-old Japanese woman due to an abdominal disorder, associated with a markedly high serum CA19-9 level (2,172.6 U/ml). After endoscopic mucosal resection was performed, the CA19-9 level was drastically decreased and normalized. The scanning view of immunohistochemical staining of CA19-9 exhibited a focal, not diffuse, positive-expression in the hyperplastic epithelium and, especially, in the irregular and fused tubular glands and the mucinous material secreted into the dilated glands. In particular, microscopic examination of the strongly CA19-9-positive areas showed structurally atypical epithelium containing mildly to focal moderately enlarged nuclei and prominent nucleoli with loss of cellular polarity, estimated as adenocarcinoma. No stromal invasion was evident. Immunohistochemically, distinct nuclear stainings for p53 and Ki-67 were seen, occasionally conforming to the CA19-9-positive atypical cells, respectively, confirmed by double immunostaining. These hyperplastic and atypical cells were classified into the pure gastric phenotype by mucin histochemical methods. Based on these features, we finally made a conclusive diagnosis of CA19-9-producing in situ well differentiated adenocarcinoma of gastric type arising in hyperplastic foveolar polyp. We suggest that the markedly high serum CA 19-9 level could be indicative of carcinoma in polyp at the very least.

Show MeSH
Related in: MedlinePlus