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Papillary adenocarcinoma with tentacular processes (with video)
AT THE FOCAL POINT Massimo Raimondo, MD, Associate Editor for Focal Points
Papillary adenocarcinoma with tentacular processes (with video)
An 83-year-old man with diabetes mellitus and hypertension presented with a complaint of belching. EGD revealed a polypoid lesion, 10 mm in diameter (A) (Video 1, available online at www.giejournal.org), with tentacular processes on the greater curvature of the gastric body. After the introduction of water into the
www.giejournal.org
stomach, each process floated up and clearly separated (B). This lesion appeared just like a sea anemone undulating in the water. Magnifying endoscopy with narrow-band imaging (M-NBI) revealed that each process was lined with white marginal crypt epithelium and contained irregular microvessels that varied in caliber (C).
Volume
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No.
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: 2016 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
Endoscopic resection was performed. The histopathologic diagnosis was papillary adenocarcinoma, composed of high columnar atypical cells with large nuclei that were partially connected to one another (D). This is a rare case of papillary adenocarcinoma with each tentacular process rising up from the base. The water immersion technique has been adopted especially for M-NBI because of its advantages of eliminating halation, achieving high spatial resolution, and expanding the depth of field to allow easy focusing on the target at the highest magnification. This method is also thought to be useful when the surface structure of polypoid lesions is examined.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Sho Sasaki, MD, Department of Gastroenterology and Hepatology, Jun Nishikawa, MD, PhD, Department of Laboratory Science, Atsushi Goto, MD, PhD, Takeshi Okamoto, MD, PhD, Isao Sakaida, MD, PhD, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan http://dx.doi.org/10.1016/j.gie.2016.05.041
Commentary The tentacled crab, and the menace such a creature entailed, was known to the ancients. The symbol of the crab comes from the giant crab Karkinos, which became an additional problem for Hercules (aka Heracles) to contend with during his battle with the Lernaean Hydra, one of the 12 labors of Hercules. Ancient physicians visualizing malignant tumors also seized on the image of the crab, given the tentacles that tumors could develop as they spread outward from their primary focus. This report describes a gastric adenocarcinoma with literal tentacles seen emanating from a central base. The images are quite striking, most notably the narrow-band image. Water immersion helped to illustrate the tentacles and separate them from one another, enhancing the image further. The authors do not state what the treatment for the patient entailed or whether or not the lesion was removed surgically or endoscopically. Although relatively small and likely easily resectable, this was nonetheless a gastric cancer and, had it not been removed, would have posed as great a risk to the patient as Karkinos did to Hercules himself. Douglas G. Adler, MD, FASGE GIE Associate Editor University of Utah School of Medicine Salt Lake City, Utah Massimo Raimondo, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2016
www.giejournal.org
Papillary adenocarcinoma with tentacular processes (with video)
An 83-year-old man with diabetes mellitus and hypertension presented with a complaint of belching. EGD revealed a polypoid lesion, 10 mm in diameter (A) (Video 1, available online at www.giejournal.org), with tentacular processes on the greater curvature of the gastric body. After the introduction of water into the
www.giejournal.org
stomach, each process floated up and clearly separated (B). This lesion appeared just like a sea anemone undulating in the water. Magnifying endoscopy with narrow-band imaging (M-NBI) revealed that each process was lined with white marginal crypt epithelium and contained irregular microvessels that varied in caliber (C).
Volume
-,
No.
-
: 2016 GASTROINTESTINAL ENDOSCOPY 1
At the Focal Point
Endoscopic resection was performed. The histopathologic diagnosis was papillary adenocarcinoma, composed of high columnar atypical cells with large nuclei that were partially connected to one another (D). This is a rare case of papillary adenocarcinoma with each tentacular process rising up from the base. The water immersion technique has been adopted especially for M-NBI because of its advantages of eliminating halation, achieving high spatial resolution, and expanding the depth of field to allow easy focusing on the target at the highest magnification. This method is also thought to be useful when the surface structure of polypoid lesions is examined.
DISCLOSURE All authors disclosed no financial relationships relevant to this publication. Sho Sasaki, MD, Department of Gastroenterology and Hepatology, Jun Nishikawa, MD, PhD, Department of Laboratory Science, Atsushi Goto, MD, PhD, Takeshi Okamoto, MD, PhD, Isao Sakaida, MD, PhD, Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan http://dx.doi.org/10.1016/j.gie.2016.05.041
Commentary The tentacled crab, and the menace such a creature entailed, was known to the ancients. The symbol of the crab comes from the giant crab Karkinos, which became an additional problem for Hercules (aka Heracles) to contend with during his battle with the Lernaean Hydra, one of the 12 labors of Hercules. Ancient physicians visualizing malignant tumors also seized on the image of the crab, given the tentacles that tumors could develop as they spread outward from their primary focus. This report describes a gastric adenocarcinoma with literal tentacles seen emanating from a central base. The images are quite striking, most notably the narrow-band image. Water immersion helped to illustrate the tentacles and separate them from one another, enhancing the image further. The authors do not state what the treatment for the patient entailed or whether or not the lesion was removed surgically or endoscopically. Although relatively small and likely easily resectable, this was nonetheless a gastric cancer and, had it not been removed, would have posed as great a risk to the patient as Karkinos did to Hercules himself. Douglas G. Adler, MD, FASGE GIE Associate Editor University of Utah School of Medicine Salt Lake City, Utah Massimo Raimondo, MD Associate Editor for Focal Points
2 GASTROINTESTINAL ENDOSCOPY Volume
-,
No.
-
: 2016
www.giejournal.org