A case of early gastric cancer in a Helicobacter pylori-negative patient treated by endoscopic submucosal dissection

Abstract

A 50-year-old man underwent esophagogastroduodenoscopy as part of a routine health screen. Endoscopic examination showed a small depressed lesion approximately 10 mm in size on the lesser curvature of the lower gastric body. Pathological examination of biopsy specimens revealed signet-ring cell carcinoma. Atrophic findings were not recognized in the background gastric mucosa, and rapid urease and serological tests were negative for Helicobacter pylori infection. Endoscopic submucosal dissection was performed. Pathological examination of the resected specimen revealed signet-ring cell carcinoma, 10×9 mm in diameter. The cancer extended to the level of the glandular neck within the lamina propia and was covered with normal crypt epithelium. It has been reported that most gastric cancers develop in patients with chronic active gastritis or chronic atrophic gastritis caused by H. pylori infection. H. pylori-negative gastric cancer is a rare disease in Japan, hence detection of H. pylori-associated gastritis has been determined a significant indicator for early detection of gastric cancer. However, H. pylori-negative gastric cancer has become more common recently because of a decrease in the incidence of H. pylori infection. Studies on the characteristic endoscopic findings for H. pylori-negative gastric cancer are required to assist diagnosis in the future.