PMC6605631_01
Esophagogastroduodenoscopy images of Case 1. (a) and (b): A diffuse miliary pattern of slightly whitish, small elevations was identified in the gastric body. (c): The elevations were emphasised on narrow-band imaging. (d): After indigo carmine spraying. (e): Granular appearance was not evident in the antrum.
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figure1
Esophagogastroduodenoscopy showed a diffuse miliary pattern with slightly whitish, small elevations in the gastric body (Figure 1a and b). The multiple granular elevations were emphasised on narrow-band imaging (Figure 1c) and after indigo carmine spraying (Figure 1d). A mild atrophic change was noted in the gastric antrum compared with the gastric body, but the granular appearance was not evident (Figure 1e).
Pathological images of Case 1. (a): Follicle formation in a biopsy specimen. (b): Monomorphic lymphocytes. (c): Cells positive for CD20. (d): Negative for CD3. (e): CD10. (f): Cyclin D1. (g) and (h): Lymphoepithelial lesions.
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figure2
A biopsy specimen from part of the small elevations of the gastric body revealed follicle formation (Figure 2a). Infiltrating lymphocytes within the follicle were monomorphic (Figure 2b) and positive for CD20 (Figure 2c), but they were negative for CD3 (Figure 2d), CD10 (Figure 2e) and Cyclin D1 (Figure 2f). Staining with haematoxylin and eosin (Figure 2g) and anti-human cytokeratin clone CAM5.2 showed lymphoepithelial lesions (Figure 2h).
Esophagogastroduodenoscopy images of Case 1. (a)-(c): 3 months. (d): 45 months after eradication of H. pylori. Small elevations disappeared and whitish spots could be partly observed in the gastric body. (b): Magnifying observation with narrow-band imaging and (c) linked colour imaging also showed that the elevations regressed. (d): Esophagogastroduodenoscopy performed 45 months after eradication of H. pylori showed vague whitish spots in the gastric body.
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Esophagogastroduodenoscopy performed 3 months after the completion of eradication treatment showed disappearance of the small elevations, while whitish spots were partly observed in the gastric body (Figure 3a-c). Esophagogastroduodenoscopy performed 45 months after achieving complete remission showed that the whitish spots had almost disappeared (Figure 3d).
PMC6605631_02
Esophagogastroduodenoscopy images of Case 2. [(a) and (b): After indigo carmine spraying] Slightly whitish, small, multiple elevations can be seen in the lesser curvature of the gastric body. (c) and (d): The small elevations regressed 5 months after H. pylori eradication.
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Esophagogastroduodenoscopy showed multiple slightly whitish, small elevations in the lesser curvature of the gastric body (Figure 4a and b). The granular appearance was not evident in the gastric antrum (Figure 4c). Esophagogastroduodenoscopy performed 5 months after H. pylori eradication revealed regression of small elevations (Figure 4c).
Pathological images in Case 2. (a) and (b): Haematoxylin and eosin staining of a biopsy specimen. (c): Cells positive for CD20. (d): Negative for CD3. (e): CD10. (f): Cyclin D1.
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figure5
Biopsy from the elevation revealed diffuse infiltration of monomorphic lymphocytes, which were predominantly positive for CD20 on immunochemical analysis (Figure 5).
Esophagogastroduodenoscopy images of Case 2 performed 29 months after the initial examination. [(a) and (b): After indigo carmine spraying] Miliary appearance re-emerged in the gastric body. (c): Magnifying observation with narrow-band imaging showed small elevations. [(d) and (e): After indigo carmine spraying] Granular appearance was not evident in the antrum.
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Five months later, multiple granular elevations remained on the lesser curvature of the gastric body (Figure 6).
Pathological images of Case 2. (a) Haematoxylin and eosin staining of a biopsy specimen. (b): Cells negative for CD3. (c) Positive for CD20. [(d) arrow and arrowhead]: Lymphoepithelial lesions were noted in cytokeratin AE1/AE3 staining. (e): Magnified views of arrow. (f): Arrowhead.
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figure7
Pathological analysis revealed infiltration of small- to medium-sized monomorphic B-cells (Figure 7a-c) showing prominent lymphoepithelial lesions (Figure 7d-f).