Gastric goblet cell adenocarcinoma

Abstract

A 75-year-old man was hospitalized with a 6 months history of intermittent abdominal pain and discomfort. The patient has a long history of hypertension and coronary heart disease. No obvious abnormalities were found in the laboratory and abdominal physical examination. Gastroscopy revealed a superficial concave lesion of approximately 1.5 × 2.0 cm in size on the anterior wall of the gastric antrum, with surrounding mucosal protrusions. We took multiple mucosal biopsies, and the pathological results of the biopsies showed intramucosal carcinoma. According to the Paris classification of early gastric cancer, the lesion is morphologically classified as 0-IIa + IIc.¹ The patient requested diagnostic endoscopic submucosal dissection (ESD). Endoscopic ultrasonography showed that the submucosa was slightly thickened and irregular (Figure 1). The lesion had a positive lift sign during the ESD, and there was no adhesion between the lesion base and surrounding tissue (Figure 1). Histologically, the lesion consists of two parts: a moderately to poorly differentiated tubular adenocarcinoma and a tumor composed of goblet mucous cells. The tumor volume ratio was about 4.5:5.5. Goblet mucous cells are arranged in a nested pattern. The nucleus is small and compressed. The cytoplasm is rich in mucin. Most tumor clusters are solid, without lumen formation, typical nuclear atypia is not significant, the nuclear division is rare, and scattered in individual panellian cells. Immunohistochemistry showed that Syn, CgA, MUC-2, MUC-5AC, and MUC-6 were partially positive. In addition, the Ki-67 proliferative index in the goblet-like cells was more than 70%. The postoperative pathology and immunohistochemical results showed goblet cell adenocarcinoma (GCA) (Figure 2). The lesion invaded the submucosal layer by 1200 microns. Subsequently, the patient was transferred to gastrointestinal surgery for additional surgical treatment.

In earlier years, this type of tumor was considered to be a mixed glandular neuroendocrine tumor, with a morphology intermediate between carcinoid and adenocarcinoma and characterized by bidirectional differentiation. In 2019, the World Health Organization named this type of tumor as the GCA. GCA mostly occurs in elderly patients and is commonly seen in the appendix,^{2, 3} as well as in the colon and anus, and is rare to occur in the stomach. GCA has a biological behavior similar to that of conventional adenocarcinoma which with aggressiveness in both histological morphology and biological behavior. Combined with immunohistochemistry helps in the diagnosis and differential diagnosis.

Jiaxing Ma contributed to writing of the manuscript. Xingjie Shen contributed to acquisition of data and Liang Liu contributed to drafting the article or revising it critically for important intellectual content.

The authors declare no conflicts of interest.

Informed consent was obtained from the patient. [Correction added on 26 October 2024, after first online publication: Ethics Statement section has been added online.]