A case of gastritis cystica polyposa is presented. A 45-year-old woman developed gastritis cystica polyposa at the gastroduodenostomy anastomotic site four years after Billroth II gastrectomy for adenomatous polyp. There was no association of gastric cancer in the lesion

Deguchi Masahiro

Hirano Tatsuo

Hirata Keizo

Ishikawa Hiroshi

Kashima Kiyotaka

Kidogawa Hideo

Kishimoto Kohji

Kusano Hiroyuki

Miura Toshio

Miyashita Kosei

Nakagoe Tohru

Okada Daikichi

Shimizu Teruhisa

Shimoyama Takatoshi

Takahira Ryoji

Tomita Masao.

Tsuji Takashi

Yamaguchi Eiichiro

Yamasaki Naoya

Nagasaki University's Academic Output SITE: NAOSITE

Acta Med. Nagasaki 35:29-32Gastritis Cystica Polyposa-Report of a Case Tatsuo HIRANO, Hiroyuki KUSANO, Kosei MIYASHITA  Daikichi OKADA, Hiroshi ISHIKAWA, Ryoji TAKAHIRA Masahiro DEGUCHI, Keizo HIRATA, Eiichiro YAMAGUCHI  Naoya YAMASAKI, Kohji KISHIMOTO, Takashi TSUJI Kiyotaka KASHIMA, Hideo KIDOGAWA, Teruhisa SHIMIZU Tohru NAKAGOE, Takatoshi SHIMOYAMA, Toshio MIURA                and Masao TOMITA.First Department of Surgery, Nagasaki University School of Medicine              Received for publication, January 13, 1990SUMMARY : A case of gastritis cystica polyposa is presented. A 45-year-old woman developed gastritis cystica polyposa at the gastroduodenostomy anastomotic site four years after Billroth II gastrectomy for adenomatous polyp. There was no association of gastric cancer in the lesion.       INTRODUCTION  Gastritis cystica polyposal) (GCP) is a rare benign condition which develops at the gastro-intestinal anastomotic site. Many nomencla-tures were given to this condition including gastritis cystica2j, multiple polypoid cystic gas-tritis'), and stomal polypoid hypertrophic gas-tritis4>. Since Qizilbash (1975)5' and Iwashita, et al (1982)6) reported the case of an association of gastric cancer, this condition has been focused on as a premalignant condition. There hitherto has been 12 cases of such a rare coexistence of the two lesions. In this paper, a case of GCP is presented. This case had no associated cancer in the stomach. Terms appearing in this paper are used according to the general rules for the gastric cancer study in surgery and pathology in Japan').        CASE REPORT  A 45-year-old woman was admitted to our hospital on April 17 in 1972 because of anorexiaand vomiting of eight months' duration. She lost 4kg in the last 10 months. She had undergone Billroth II gastrectomy for gastric polyps (adenomatous polyps) in 1968 at her age of 41.  A stomach polyp was detected at the anastomotic site on the upper GI series and endoscopic examination in June 1970. Since that time she had been followed-up periodically. Because she developed the above symptoms and the polyp increased in size, she was readmitted to the hospital for operation. Her past history included appendectomy at 24, and her family history showed her father died of gastric cancer at her 62 years of age.  Physical examination on admission was not remarkable. The previous operation scars were seen at the upper abdominal midline and the right lower quadrant. Her blood pressure was 104/66 mmHg, pulse 90/minute regular, body temperature 36.6'C. Laboratory data showed RBC 408 X 104/mm3, Hb 11.8g%, Hct 37%, white blood cell count 2,700/mm3 with 1% of basophile, 3% of eosinophils, 2% of bands, 44% of polymorphs, and 50% of lymphs. The platelet counts were6.1 x 10'/mm'. The liver and renal function tests and serum electrolytes were all within normal limits, including a total protein of 6.3g%, albumin of 3.8g%.  A barium swallow showed a polypoid tumor, measuring 2cm, at the greater curvature side of the anastomotic site and a filling defect being 1cm in width along the anastomotic site. An endoscopic examination showed three polypoid lesions at the anastomotic site.  At operation (May 2, 1972), the initial operation was found to be Billroth II type gastrectomy in a retrocolic fashion with no Braun's anasto-mosis. The anastomotic site was about two times as thick as usual, and a polypoid mass was palpable at the greater curvature side. After the stomach and jejunum around the anasto-motic area were resected, the gastrointestinal continuity was restored by making a BillrothFig. 2. A polypoid lesion at the gastrojejunostomy        site. Arrow indicates the anastomotic       junction (H & E, X3.3).Fig. 3. Microscopic findings of the polypoid lesion      (H & E, x 10)Fig. 1. The resected specimen showing a polypoid       lesion and a giant fold along the gastro-      jejunostomy anastomotic site with a fine-       nodular surfaceI anastomosis. The resected specimen showed a polypoid lesion at the greater curvature and a protruded fold of the stomach along the gastrojejunal anastornotic site (Fig. 1). The surface of the lesion was fine-nodular, similar to the brain convolution seen in the giant rugaeof Menetrier's disease. A histologic examination showed elongation of the gastric pits, hyper-plasia and cystic dilatation of the pseudopyloric glands and their submucosal invasion (Figs. 2 and 3). The diagnosis of GCP was established. There was no evidence of malignancy.  The patient is well and has no symptoms or signs of recurrence of GCP at the time 19 years after the second gastric resection.          DISCUSSION  The first case of GCP was documented in 1965 by Nickolai and Muller2 as gastritis cystica. Since then the detection of these lesions has increased steadily. In Japan, the first case of GCP was described by Kameyama, et al.8) in 1972. GCP develops mostly in men following Billroth II gastrectomy and rarely following gastroenteric anastomosis4,9,1O) The interval from the first operation ranges from six months to 42 years').  Recently GCP has been focused on as a possible precancerous lesion. To our know-ledge, only three cases of GCP associated with gastric cancer have been reported in the western literature5.y.1o.11). In Japan, Iwashita documentes the first case of a coexistence of GCP and focal early carcinoma, and since then ten cases have been reported as listed in Table 1. Franzin, eta1.11) considered that GCP is a possible precan cerous lesion because of the similarties of the site and the histologic features of GCP to those of experimental stomal polyps in rats after partial gastrectomy. They stated that the most common histologic changes in case of GCP were atrophy of gastic glands, cystic dilatation of gastric glands, intestinal metaplasia and dysplastic changes which occur early in the postoperative period ; and that local chronic ischemia and inflammatory reaction as a consequence of gastric surgery and suture at gastroenterostomy together with bile reflux and increase in gastric pH were responsible for the development of GCP and carcinoma. Our patient had no association of cancer. However, a special attention should be paid to the sub-sequent development of carcinoma from GCP.          REFERENCES 1) Littler ER, Gleibermann E : Gastritis cystica    polyposa (Gastric mucosal prolapse at gastro-   enterostomy site, with cystic and infiltrative    epithelial hyperplasia). Cancer 29: 205-9, 1972. 2) Nickolai N and Muller D : Das klinische and    pathologischanatomische Blid der Gastritis    cystica. Brum Beitr Kin Chir 210: 367-78, 1965. 3) Griffel B, Engleberg M, Reiss R : Multiple    polypoid cystic gastritis in old gastroenteric    stoma. Arch Pathol 97:316-8, 1974.Table 1. Ten reported cases of gastritis cystica polyposa associated with cancer of    the stomach in the Japanese literatureYear Author First Time Early gastric cancer                operation interval' Type Histology Size''' Depth 1982 Iwashita B-II 18y I tubs m 1982 Fukuchi B-II 19y IIa tubs 2X2 m 1982 Kondo B-II 19y elevated por 5X3 pin                                      elevated tube 1.5 x 1 sm1982 Kondo B-II 21y elevated por 3.5 x 3 pin 1986 Okamoto B-II 26y IIc tube 7 x 1.5 sm 1987 Ishikawa B-II 16y I tubs 3.5 x 3 sm 1988 Hosokawa B-II 28y I tubs 0.7 x 0.7 m 1988 Hosokawa B-II 25y I tube 7X4 sm 1988 Hosokawa B-II 23y IIa+IIc sig 4X3 sm 1988 Lien B-II 36y IIa+IIc tube 1.6x1.5 m                                         IIc tube 0.4 x 0.3 m* : years from the first gastrectomy, * * : centimeters, B-1: Billroth-I gastrectomy, B-II : Billroth-II gastrectomy, tubs : well differentiated adenocarcinoma, tube : moderately differentiated adenocarcinoma, por : poorly differentiated adenocarcinoma, sig : signet ring cell carcinoma, m : mucosal cancer, sm : submucosal cancer4) Koga S, Watanabe H, Enjoji M : Stomal polypoid    hypertrophic gastritis. Cancer 43 : 647-57, 1979. 5) Qizilbash AH : Gastritis cystica and carcinoma    arising in old gastrojejunostomy stoma. CMA   Journal 112: 1432-3, 1975. 6) Iwashita A, Kuroiwa S, Enjoji M, et al: Early    gastric carcinoma, type I, occurring in stomal   polypoid hypertrophic gastritis (SPHG). I to Cho   (Stomach and Intestine) 17: 1333-9, 1982. 7) Japanese Research Society for Gastric Cancer :    The general rules for the gastric cancer study   in surgery and pathology in Japan. Jpn j Surg   11 :127-145, 1981.8) Kameyama H, Matsumori H, Takagi M, et al:    Gastric polyps at the site of anastomosis after    gastric resection. Surg Diag Treat 14:1504-8,   1972. 9) Delpre G, Kadish U, Avidor I: Incidental    procurement of gastric biopsy. Endoscopy 14: 34,   1982. 10) Delpre G, Glanz I, Neeman A, et al: New    therapeutic approach in post-operative phy-   tobezoars. J Clin Gastroenterol 6:231-7, 1984 11) Franzin G, Musola R, Zamboni G, et al.: Gastritis    cystica polyposa : a possible precancerous    lesion. Tumori 71:13-8, 1985.

Gastritis Cystica Polyposa-Report of a Case

https://nagasaki-u.repo.nii.ac.jp/?action=repository_action_common_download&item_id=21902&item_no=1&attribute_id=18&file_no=1

Gastritis Cystica Polyposa-Report of a Case

Abstract

Similar works

Full text

Available Versions

Nagasaki University's Academic Output SITE: NAOSITE