Gastritis Cystica Profunda: A Rare Gastric Tumor Masquerading as a Malignancy

Joseph L. Laratta, Tatiana N. Buhtoiarova, Lauren S. Sparber, Ronald S. Chamberlain

Department of Pathology, Saint Barnabas Medical Center, Livingston, NJ, USA.
Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA.
Department of Surgery, University of Medicine & Dentistry of New Jersey, Newark, NJ, USA.
Department of Surgery, University of Medicine & Dentistry of New Jersey, Newark, NJ, USA; Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; St. George’s University School of Medicine, Grenada, West Indies.

DOI: 10.4236/ss.2012.33031                

Abstract

Introduction: Gastritis cystica profunda (GCP) is a rare tumor which occurs more commonly in patients with prior gastric surgery. The nonspecific symptoms and radiographic appearance of this tumor mimic that of other hyperproliferative conditions making diagnosis difficult without definitive surgical resection. This report provides a comprehen-sive review of GCP and all GCP cases reported to date. Methods: A comprehensive literature search (1972-2011) was conducted with all reported GCP cases analyzed. Keywords searched included gastritis cystica profunda, submucosal cysts of the stomach, and heterotopic submucosal gastric glands. Results: Thirty-seven GCP cases have been reported since 1972, which includes 29 (78%) men and 8 (21%) women (M:F ratio, 3.6:1). The overall mean age was 60.5 years (range, 39 - 81 years) with 55.6 years (range, 39 - 79) and 62.2 years (range, 39 - 81 years) in women and men, respectively. 65% (N = 24) had prior gastric surgery. 62% (N = 23) of GCP tumors were located in the body; 24% (N = 9) in the fundus; 8% (N = 3) in the antrum; or 6% (N = 2) in the cardia of the stomach. GCP was an incidental finding in 19% of patients. Complete excision was performed most often (73%) followed by endomucosal resection (18%), and polypectomy (4.5%). One patient underwent surveillance (4.5%). Conclusions: GCP is a rare gastric tumor, which is difficult to diagnose preoperatively and masquerades as a malignancy. GCP is more common in men and typically presents with nonspecific symptoms. Although a benign lesion, GCP may represent an intermediate histology in the malignant progression to gastric neoplasia. To date, there have been no reports of local recurrence or distant metastasis following definitive surgical excision, which remains the standard of care.

Keywords

Gastritis Cystica Polyposa; GCP; Submucosal Cysts of the Stomach; Heterotopic Submucosal Gastric Glands

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	E. R. Littler and E. Gleibermann, “Gastritis Cystica Polyposa. Gastric Mucosal Prolapse at Gastroenterostomy Site, with Cystic and Infiltrative Epithelial Hyperplasia,” Cancer, Vol. 29 No. 1, 1972, pp. 205-209. doi.org/10.1002/1097-0142(197201)29:1<205::AID-CNCR2820290130>3.0.CO;2-J
[2]	G. Franzin and P. Novelli, “Gastritis Cystica Profunda,” Histopathology, Vol. 5, No. 5, 1981, pp. 535-547. doi.org/10.1111/j.1365-2559.1981.tb01817.x
[3]	D. Béchade, J. Desramé and J. P. Algayres, “Gastritis Cystica Profunda in a Patient with No History of Gastric Surgery,” Endoscopy, Vol. 39, 2007, pp. 80-81. doi.org/10.1055/s-2006-945070
[4]	J. K. Lim, Y. J. Jang, M. K. Jung, H. K. Ryeom, G. C. Kim and J. Bae, “Ménétrier Disease Manifested by Polyposis in the Gastric Antrum and Coexisting with Gastritis Cystica Profunda,” Gastrointestinal Endoscopy, Vol. 72, No. 5, 2010, pp. 1098-1100. doi.org/10.1016/j.gie.2010.02.020
[5]	M. Okada, Y. Iizuka, K. Oh, H. Murayama and T Maekawa, “Gastritis Cystica Profunda Presenting as Giant Gastric Mucosal Folds: The Role of Endoscopic Ultrasonography and Mucosectomy in the Diagnostic Work-Up,” Gastrointestinal Endoscopy, Vol. 40, No. 5, 1994, pp. 640-644. doi.org/10.1016/S0016-5107(94)70272-1
[6]	S. K. Moon, K. O. Kim, S. H. Park, K. S. Yoo, C. H. Park, J. H. Kim, C. K. Park and S. Y. Jun, “Gastritis Cystica Profunda Accompanied by Multiple Early Gastric Cancers,” Korean Journal of Gastroenterology, Vol. 55, No. 5, 2010, pp. 325-330. doi.org/10.4166/kjg.2010.55.5.325
[7]	T. Tsuji, M. Iwahashi, M. Nakamori, K. Ueda, K. Ishida, T. Naka, T. Ojima, H. Akamatsu and H. Yamaue, “Multiple Early Gastric Cancer with Gastritis Cystica profunda Showing Various Histological Types,” Hepatogastroenterology, Vol. 55, No. 84, 2008, pp. 1150-1152.
[8]	M. Yamashita, M. Hirokawa, M. Nakasono, H. Kiyoku, N. Sano, M. Fujii, T. Koyama, S. Yoshida and T. Sano, “Gastric Inverted Hyperplastic Polyp. Report of Four Cases and Relation to Gastritis Cystica Profunda,” APMIS, Vol. 110, No. 10, 2002, pp. 717-723. doi.org/10.1034/j.1600-0463.2002.1101005.x
[9]	E. C. Fonde and C. B. Rodning, “Gastritis Cystica Profunda,” American Journal of Gastroenterology, Vol. 81, No. 6, 1986, pp. 459-464.
[10]	J. S. Park, S. J. Myung, H. Y. Jung, S. K. Yang, W. S. Hong, J. H. Kim, G. H. Kang, H. K. Ha and Y. I. Min, “Endoscopic Treatment of Gastritis Cystica polyposa Found in an Unoperated Stomach,” Gastrointestinal Endoscopy, Vol. 54, No. 1, 2001, pp. 101-103. doi.org/10.1067/mge.2001.114412
[11]	T. Kamata, “Experimental Studies on the Development of residual Stomach Cancer—Comparison of Billroth I and Billroth II,” Nippon Geka Gakkai Zasshi, Vol. 94, No. 2, 1993, pp. 104-113.
[12]	S. Koga, H. Watanabe and M. Enjoji, “Stomal Polypoid Hypertrophic Gastritis: A Polypoid Gastric Lesion at Gastroenterostomy Site,” Cancer, Vol. 43, No. 2, 1979, pp. 647-657. doi.org/10.1002/1097-0142(197902)43:2<647::AID-CNCR2820430236>3.0.CO;2-Y
[13]	K. Mukaisho, K. Miwa, H. Kumagai, M. Bamba, H. Sugihara and T. Hattori, “Gastric Carcinogenesis by Duodenal Reflux through Gut Regenerative Cell Lineage,” Digestive Diseases and Sciences, Vol. 48, No. 11, 2003, pp. 2153-2158. doi.org/10.1023/B:DDAS.0000004519.26201.a4
[14]	A. H. Qizilbash, “Gastritis Cystica and Carcinoma Arising in Old Gastrojejunostomy Stoma,” Canadian Medical Association Journal, Vol. 112, No. 12, 1975, pp. 1432-1433.
[15]	H. Mitomi, K. Iwabuchi, A. Amemiya, G. Kaneda, K. Adachi and T. Asao T, “Immunohistochemical Analysis of a Case of Gastritis Cystica Profunda Associated with Carcinoma Development,” Scandinavian Journal of Gastroenterology, Vol. 33, No. 11, 1998, pp. 1226-1229. doi.org/10.1080/00365529850172610
[16]	T. K. Roepke, K. Purtell, E. C. King, K. M. La Perle, D. J. Lerner and G. W. Abbott, “Targeted Deletion of Kcne2 Causes Gastritis Cystica Profunda and Gastric Neoplasia,” PLoS One, Vol. 5, No. 7, 2010, p. e11451. doi.org/10.1371/journal.pone.0011451
[17]	M. Vauhkonen, H. Vauhkonen and P. Sipponen, “Pathology and Molecular Biology of Gastric Cancer,” Best Practice and Research Clinical Gastroenterology, Vol. 20, No. 4, 2006, pp. 651-674. doi.org/10.1016/j.bpg.2006.03.016
[18]	R. Kochhar, P. Manoharan, M. Leahy and M. B. Taylor, “Imaging in Gastrointestinal Stromal Tumours: Current Status and Future Directions,” Clinical Radiology, Vol. 65, No. 8, 2010, pp. 584-592. doi.org/10.1016/j.crad.2010.02.006
[19]	T. Tomizuka, T. Mazaki, K. Mado, A. Henmi, Y. Ishii, H. Masuda and T. Takayama, “A Case of Gastritis Cystica Profunda,” Surgery, Vol. 143 No. 3, 2008, pp. 449-450. doi.org/10.1016/j.surg.2007.02.009
[20]	J. A. Laurini and J. E. Carter, “Gastrointestinal Stromal Tumors: A Review of the Literature,” Archives of Pathology and Laboratory Medicine, Vol. 134, No. 1, 2010, pp. 134-141.
[21]	C. D. Fletcher, J. J. Berman, C. Corless, F. Gorstein, J. Lasota, B. J. Longley, M. Miettinen, T. J. O'Leary, H. Remotti, B. P. Rubin, B. Shmookler, L. H. Sobin and S. W. Weiss, “Diagnosis of Gastrointestinal Stromal Tumors: A Consensus Approach,” International Journal of Surgical Pathology, Vol. 10, No. 2, 2002, pp. 81-89. doi.org/10.1177/106689690201000201
[22]	K. Akahoshi and M. Oya, “Gastrointestinal Stromal Tumor of the Stomach: How to Manage?” World Journal of Gastrointestinal Endoscopy, Vol. 2, No. 8, 2010, pp. 271-277. doi.org/10.4253/wjge.v2.i8.271
[23]	V. Itte, I. H. Mallick and P. J. Moore, “Massive Gastrointestinal Haemorrhage Due to Gastritis Cystica Profunda,” Cases Journal, Vol. 1, No. 1, 2008, p. 85.
[24]	J. Kurland, S. DuBois, C. Behling and T. Savides, “Severe Upper-GI Bleed Caused by Gastritis Cystica Profunda,” Gastrointestinal Endoscopy, Vol. 63, No. 4, 2006, pp. 716-717. doi.org/10.1016/j.gie.2005.11.027
[25]	M. T. Wu, H. B. Pan, P. H. Lai, J. M. Chang, S. H. Tsai and C. W. Wu, “CT of Gastritis Cystica Polyposa,” Abdominal Imaging, Vol. 19, No. 1, 1994, pp. 8-10. doi.org/10.1007/BF02165852
[26]	A. Machairas, E. Karamitopoulou, D. Tsapralis, T. Karatzas, N. Machairas and E. P. Misiakos, “Gastrointestinal Stromal Tumors (GISTs): An Updated Experience,” Digestive Diseases and Sciences, Vol. 55, No. 12, 2010, pp. 3315-3327. doi.org/10.1007/s10620-010-1360-9
[27]	M. Miettinen and J. Lasota, “Gastrointestinal Stromal Tumors: Review on Morphology, Molecular Pathology, Prognosis, and Differential Diagnosis,” Archives of Pathology and Laboratory Medicine, Vol. 10, 2006, pp. 1466-1478.
[28]	J. L. Rubin, M. Sanon, D. C. Taylor, J. Coombs, V. Bollu and L. Sirulnik, “Epidemiology, Survival, and Costs of Localized Gastrointestinal Stromal Tumors,” International Journal of General Medicine, Vol. 4, 2011, pp. 121-130.
[29]	National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, “Surveillance, Epidemiology, and End Results (SEER) Program Research Data (1973-2008),” 2011. http://www.seer.cancer.gov/
[30]	R. P. DeMatteo, J. J. Lewis, D. Leung, S. S. Mudan, J. M. Woodruff and M. F. Brennan, “Two Hundred Gastrointestinal Stromal Tumors: Recurrence Patterns and Prognostic Factors for Survival,” Annals of Surgery, Vol. 231, No. 1, 2000, pp. 51-58. doi.org/10.1097/00000658-200001000-00008
[31]	G. F. Cenitagoya, C. K. Bergh and J. Klinger-Roitman, “A Prospective Study of Gastric Cancer. ‘Real’ 5-Year Survival Rates and Mortality Rates in a Country with High Incidence,” Digestive Surgery, Vol. 15, No. 4, 1998, pp. 317-322. doi.org/10.1159/000018645
[32]	P. S. Sepe and W. R. Brugge, “A Guide for the Diagnosis and Management of Gastrointestinal Stromal Cell Tumors,” Nature Reviews Gastroenterology and Hepatology, Vol. 6, No. 6, 2009, pp. 363-371. doi.org/10.1038/nrgastro.2009.43
[33]	B. M. Yan, G. G. Kaplan, S. Urbanski, C. L. Nash and P. L. Beck, “Epidemiology of Gastrointestinal Stromal Tumors in a Defined Canadian Health Region: A Population-Based Study,” International Journal of Surgical Pathology, Vol. 16, No. 3, 2008, pp. 241-250. doi.org/10.1177/1066896907306967
[34]	A. Srivastava and G. Y. Lauwers, “Gastric Epithelial Dysplasia: The Western Perspective,” Digestive and Liver Disease, Vol. 40, 2008, pp. 641-649. doi.org/10.1016/j.dld.2008.02.039
[35]	H. J. Wanebo, B. J. Kennedy, J. Chmiel, G. Steele Jr., D. Winchester and R. Osteen, “Cancer of the Stomach. A Patient Care Study by the American College of Surgeons,” Annals of Surgery, Vol. 218, No. 5, 1993, pp. 583-592. doi.org/10.1097/00000658-199321850-00002
[36]	F. F. Chou, H. L. Eng and S. M. Sheen-Chen, “Smooth Muscle Tumors of the Gastrointestinal Tract: Analysis of Prognostic Factors,” Surgery, Vol. 119, No. 2, 1996, pp. 171-177. doi.org/10.1016/S0039-6060(96)80165-6
[37]	T. L. Ang, C. J. Khor and T. Gotoda, “Diagnosis and Endoscopic Resection of Early Gastric Cancer,” Singapore Medical Journal, Vol. 51, No. 2, 2010, pp. 93-100.
[38]	A. Matsukuma, M. Furusawa, H. Tomoda and Y. Seo, “A Clinicopathological Study of Asymptomatic Gastric Cancer,” British Journal of Cancer, Vol. 74, No. 10, 1996, pp. 1647-1650. doi.org/10.1038/bjc.1996.603