case_images: PMC5139839_01
case_images: Endoscopic findings of the proximal antrum in the first patient (a 39 years old woman). (A) Initial findings showed micronodules measuring 2-5 mm in diameter with a smooth surface. The findings are observed from the antrum to the low corpus of the stomach, indicating a diffuse-type nodular gastritis. (B) There were no remarkable changes in nodular elevation on chromoendoscopic findings 1 month after H. pylori eradication, even after applying 0.2% indigo carmine spray. There was also no change in diffuse-type nodular gastritis since the previous examination. (C) Indigo carmine (0.2%) chromoendoscopy conducted 3 months after successful H. pylori eradication revealed, diminished nodular elevations.
case_images: gr-03-041-g001.jpg
case_images: PMC5139839_01_gr-03-041-g001.jpg
case_images: F1
case_images: On the upper gastrointestinal endoscopic examination, diffuse mucosal nodularity with a cobblestone appearance was noticed (Fig. 1A). Cobblestone appearance indicating diffuse-type nodular gastritis was still noticed from the antrum to lower corpus (Fig. 1B). Follow up endoscopic examination with multiple biopsies showed an improvement of nodular gastritis (Fig. 1C).
case_images: Histologic findings of biopsied specimens from the anterior aspect of the antrum in the first patient. (A) On microscopic findings at a low magnification, the nodular mucosa is expanded by a marked lymphoplasma cell infiltration with the presence of a prominent germinal center (H&E stain, x100). (B) On microscopic findings at a higher magnification, diffuse lymphoplasma cell infiltration is noted in the lamina propria, and a few lymphocytes are infiltrating the epithelium. Low grade gastric MALT lymphoma is suspected, but no definite lymphoepithelial lesion is found (H&E stain, x400).
case_images: gr-03-041-g002.jpg
case_images: PMC5139839_01_gr-03-041-g002.jpg
case_images: F2
case_images: Biopsy was taken at the anterior aspect of the antrum, and was reported as H. pylori-infected lesion suggestive of low grade gastric MALT lymphoma (Fig. 2).
case_images: PMC5139839_02
case_images: Gross findings of endoscopy and surgical specimens in the second patient (a 30 years old woman). (A) Chromoendoscopic findings with application of 0.2% indigo carmine showed diffuse mucosal nodularity evident on the antrum and lower corpus of the stomach, leading to a diagnosis of diffuse-type nodular gastritis. A round, elevated lesion with central ulceration can be seen on the anterior aspect of the proximal antrum. The edge and base of the ulcer are irregular and uneven, suggesting a cancerous change. (B) A 3.2 x 2.0 x 1.0 cm Borrmann type III gastric cancer was completely resected surgically by subtotal gastrectomy, with negative resection margins.
case_images: gr-03-041-g003.jpg
case_images: PMC5139839_02_gr-03-041-g003.jpg
case_images: F3
case_images: On the upper gastrointestinal endoscopic examination, a 3 cm sized ulcerated lesion was detected (Fig. 3A). The tumor was resected by subtotal gastrectomy (Fig. 3B) with multiple lymph node dissections.
case_images: Histological findings of the resected gastric cancer in the second patient. (A) On microscopic findings at a low magnification, mononuclear cell infiltration with germinal centers is noted in the mucosa and submucosa around the gastric cancer (H&E stain, x40). (B) On microscopic findings at a higher magnification, a poorly differentiated tubular adenocarcinoma is evident near the lymphoid follicle in the mucosa (H&E stain, x400).
case_images: gr-03-041-g004.jpg
case_images: PMC5139839_02_gr-03-041-g004.jpg
case_images: F4
case_images: Histopathological result showed a poorly differentiated adenocarcinoma invading down to the subserosal level with lymphatic and perineural invasions (Fig. 4).