GNAS-mutated carcinoma arising from gastric foveolar metaplasia in the duodenum after 9 years of observation

  • Yasumasa Matsuo
  • Hiroyuki Yamamoto
  • Yoshinori Sato
  • Ritsuko Oikawa
  • Tadateru Maehata
  • Takashi Fujino
  • Naohisa Yahagi
  • Hiroshi Yasuda
  • Masayuki Takagi
  • Fumio Itoh
Case Report
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Abstract

This case involved an 80-year-old man. Screening with esophagogastroduodenoscopy (EGD) in 2004 revealed Brunner’s gland hyperplasia (BGH), 5 mm in size, in the duodenal bulb. The size of the lesion increased and its shape has changed since then, as detected in subsequent EGDs. The lesion had increased in size to 15 mm with a depression and biopsy specimens revealed an adenocarcinoma. The patient underwent endoscopic mucosal resection. Histopathological assessments indicated an adenocarcinoma arising from gastric foveolar metaplasia (GFM) adjacent to BGH. BGH stained positive for MUC6, and GFM and the adenocarcinoma stained positive for MUC5AC. Mutations of the GNAS gene were not detected in the GFM biopsied in 2007. On the other hand, common GNAS mutations (R201H) were detected in GFM and the adenocarcinoma in the endoscopically resected specimen in 2013. Moreover, mutant allele frequencies were higher in the carcinoma than in GFM. The patient remains disease-free for 4 years after endoscopic treatment. This case report further supports the notion that GFM may be a precursor lesion in the process of GNAS-mutated, gastric-type duodenal carcinogenesis.

Keywords

Gastric foveolar metaplasia Gastric-type duodenal cancer GNAS mutation Pyrosequencing MUC5AC 

Notes

Compliance with ethical standards

Conflict of interest

Yasumasa Matsuo, Hiroyuki Yamamoto, Yoshinori Sato, Ritsuko Oikawa, Tadateru Maehata, Takashi Fujino, Naohisa Yahagi, Hiroshi Yasuda, Masayuki Takagi, and Fumio Itoh declare that they have no conflict of interest.

Human and animal rights statements

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Yasumasa Matsuo
    • 1
  • Hiroyuki Yamamoto
    • 1
  • Yoshinori Sato
    • 1
  • Ritsuko Oikawa
    • 1
  • Tadateru Maehata
    • 2
  • Takashi Fujino
    • 3
  • Naohisa Yahagi
    • 2
  • Hiroshi Yasuda
    • 1
  • Masayuki Takagi
    • 4
  • Fumio Itoh
    • 1
  1. 1.Division of Gastroenterology and Hepatology, Department of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
  2. 2.Division of Research and Development for Minimally Invasive Treatment, Cancer CenterKeio University School of MedicineTokyoJapan
  3. 3.Department of PathologySaitama Medical University International Medical CenterHidakaJapan
  4. 4.Department of PathologySt. Marianna University School of MedicineKawasakiJapan

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