A Case of Gastric Inverted Hyperplastic Polyp Found with Gastritis Cystica Profunda and Early Gastric Cancer
A 77-year-old male was admitted to undergo gastric endoscopic submucosal dissection. He had been diagnosed with a metachronous early gastric cancer on the posterior wall of the mid body 2 weeks before the admission. In the past history, he had undergone endoscopic submucosal dissection due to early gastric cancer on the anterior wall of the antrum of the stomach and gastric polypectomy due to multiple hyperplastic polyps in the stomach 1 year and 8 months before the admission. On admission, the physical examination was unremarkable. Complete blood count results showed white blood cell of 5,800/mm3, hemoglobin of 13.1 g/dL, and platelet of 214,000/mm3. The blood chemistry was analyzed as total protein of 7.6 g/dL, albumin of 4.1 g/dL, total bilirubin of 0.6 mg/dL, aspartate aminotransferase of 33 IU/L, alanine aminotransferase of 23 IU/L, alkaline phosphatase of 51 IU/L, serum creatinine of 1.4 mg/dL, total cholesterol of 176 mg/dL, and fasting blood glucose of 97 mg/dL. Endoscopic examination demonstrated superficial depressed lesion with spontaneous bleeding on the posterior wall of the mid body (). He underwent endoscopic submucosal dissection successfully.\nThe resected specimen was 4.5×3×0.5 cm and had 1.5×0.5-cm superficial depressed lesion in the center (). Microscopically, 1.5×0.5-cm-sized, well-differentiated tubular adenocarcinoma was noted. It was confined to the mucosa and did not have involvement of lateral and deep margins, lymphatic invasion, vascular invasion, and perineural invasion. In addition, gastritis cystica profunda was also noted in the submucosa. Especially, nodular inverted proliferation of the normal appearing gastric epithelium and glands in the submucosa was noted in the center of the resected specimen. It measured 5 mm and showed mild glandular atypia. It was diagnosed to be a gastric IHP (). He was discharged without special complications after the endoscopic submucosal dissection.