• Lifeng Liu, Lin Han, Qingzhu Ma, and Jinliang Zhang.
• Department of Gastroenterology.
• Medicine (Baltimore). 2021 May 28; 100 (21): e25861e25861.

RationaleGastric adenocarcinoma of fundic gland (chief cell predominant type) (GA-FG-CCP) is a new, rare variant of gastric adenocarcinoma, which is characterized by mild nuclear atypia and specific immunohistochemical markers.Patient ConcernsAn 84-year-old Chinese man was referred to our hospital for endoscopic resection of a gastric lesion.InterventionsWe performed endoscopic submucosal dissection, and successfully removed the lesion.DiagnosisEsophago gastroduodenoscopy showed a slightly elevated lesion with a diameter of 22 mm in the posterior wall of cardia. Magnifying endoscopy with narrow band imaging revealed an abnormal microsurface and microvessels on the tumor surface. Endoscopic ultrasonography revealed a hypoechoic mass located in the first layer. The pathological diagnosis of the biopsy specimens indicated that the tumor was high grade intraepithelial neoplasia. The pathological diagnosis differed between the superficial and deeper part of the lesion. The superficial part was composed of a tubular structure with prominent atypia and was diagnosed as well differentiated intestinal adenocarcinoma. The deeper part was composed of a well-differentiated tubular adenocarcinoma mimicking the fundic gland cells, mainly the chief cells. The tumor cells showed mild nuclear atypia and was positive for pepsinogen-I (PG-I) and mucin-6 (MUC6). This deeper part was diagnosed as GA-FG-CCP.OutcomesThe tumor was successfully removed. This patient had no discomfort during the follow-up period (10 months).LessonsWe present a rare case of GA-FG-CCP coexisted with well-differentiated tubular adenocarcinoma. GA-FG-CCP exists in the deep mucosal layer and the muscularis mucosa, which could not be found under endoscopy, but could be discerned in pathology with mild nuclear atypia and special biomarkers.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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