LAUSR

Endoscopic features of fundic gland type gastric adenocarcinoma (GA-FG) have recently been established (1, 2) but are not well-known worldwide. We encountered an instructive case of GA-FG in a 61-year-old woman. Screening esophagogastroduodenoscopy revealed a whitish, submucosal tumor-like protrusion with dilated vessels and a black spot in multiple fundic gland polyps (FGPs) in the fornix (Picture 1, 2). A regular arrangement of collecting venules (RAC) was found in the background. Narrow-band imaging showed dilatation of the crypt opening and intervening part (Picture 3). Endoscopic submucosal dissection was performed and histopathology(Picture 4) demonstrated well differentiated tubular adenocarcinoma (tub1), gastric type, 9×6 mm, pT1b (pSM2), UL(-), Ly0, V0, pHM0, pVM0. The patient was carefully followed after considering the invasiveness and obtaining her informed consent. Cases of multiple FGPs with RAC should be investigated and attention should be paid to submucosal tumor-like protrusion with dilated vessels, so that the diagnosis of GA-FG is not missed.