PMC6232817_01
Esophagogastroduodenoscopy images of Case 1. Atrophy is predominantly observed in the gastric fornix (a) and body (b), while it is not evident in the antrum (c). Close-up observation of the gastric fornix shows multiple white substances (d). Magnifying observation with narrow-band imaging reveals microvasculature on its surface (e).
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fig1
Esophagogastroduodenoscopy revealed gastric atrophy predominantly in the fornix (Figure 1(a)) and in the body (Figure 1(b)), whereas atrophic changes were not evident in the antrum endoscopically (Figure 1(c)). Close-up observation of the gastric fornix showed multiple, slightly elevated, round, white substances (Figure 1(d)). Magnified observation with narrow-band imaging revealed microvasculature on its surface, suggesting deposition of the white substance within the mucosa (Figure 1(e)).
Pathology images of Case 1. Biopsy specimens taken from the gastric mucosa with white globe appearance show cystic dilatation of the gastric glands (hematoxylin and eosin staining, (a): x4.2, (b): x20).
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fig2
Two biopsy specimens taken from the gastric mucosa that contained white substance revealed cystic dilatation of the gastric glands (Figure 2).
PMC6232817_02
Esophagogastroduodenoscopy images of Case 2. Atrophy is more prominent in the fornix (a), compared to the antrum (b). Multiple white substances are seen in the gastric fornix and in the body after indigo carmine spraying (c, d). Microvasculature is also observed on magnified observation with narrow-band imaging (e).
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fig3
Esophagogastroduodenoscopy showed diffuse gastric atrophy; the atrophic changes were more prominent in the fornix (Figure 3(a)) than in the antrum (Figure 3(b)). After indigo carmine spraying, we noticed multiple, slightly elevated, round, white substances in the gastric fornix and body (Figures 3(c) and 3(d)). Microvasculature was also noted on its surface as seen on the magnified observation with narrow-band imaging (Figure 3(e)).
Pathology images of Case 2. Biopsy from the gastric mucosa shows cystically dilated glands (hematoxylin and eosin staining, (a): x4.2, (b): x10, (c): x20). Immunohistochemical study shows that pepsinogen-positive cells ((d), x4.2) are present, whereas H+/K+ ATPase-positive cells are absent ((e), x4.2).
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fig4
Biopsy from the gastric mucosa showed cystically dilated gastric glands (Figures 4(a)-4(c)). Immunohistochemically, pepsinogen-positive cells were present (Figure 4(d)), whereas H+/K+ ATPase-positive cells were absent (Figure 4(e)).
Esophagogastroduodenoscopy images of Case 2. Endoscopy performed 12 months later shows no white substances even in the gastric fornix ((a): white light, (b): narrow-band imaging).
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fig5
White substances were not detected in the gastric mucosa, even in the gastric fornix and body (Figure 5).