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Background: Gastric type adenocarcinoma with fundic gland differentiation (GA-FG) has been reported as a new, rare, chief cell differentiation composed carcinoma. Clinicopathologically, it exists on the gastric cardia/fundus, with low proliferative activity and low-grade malignancy. Until now, there has been no report of this GA-FG type cancer in the duodenum. We firstly planned to resect the tumor with endoscopic mucosal resection with a cap-fitted endoscope (EMR-C). Nevertheless a large amount of 0.4% sodium hyaluronate solution was injected into the submucosal layer because mucosal lesions could not be adequately lifted. A 67-year-old male was routinely seen at a hospital after a rectal cancer operation in December 2005. Every year he received a GI fiber examination. Five years after the operation, gastric endoscopic examination revealed a small nodular lesion at the bulbus, and subsequently a mucosal biopsy was performed (Figure 1a). Microscopically, the biopsy specimen demonstrated characteristics of gastric adenocarcinoma of fundic gland type. Laboratory examinations revealed that all parameters were within normal limits. CT scan showed no duodenal wall invasion to pancreas and no lymph node metastases. Case presentation: In this case, we report a case that coincidentally diagnosed GA-FG neighboring to Brunner’s glands hyperplasia in the duodenum, and successfully resected by ESD (Endoscopic Submucosal Dissection). Unfortunately, owing to a thin submucosal, pin hole perforation was caused while snaring the tumor. Endoscopic 4 clippings, expelled remaining abdominal air, and 2 weeks non oral in take was cured acute peritonitis. Conclusions: We report the experience of the rare case of Gastric type adenocarcinoma with fundic gland differentiation in the duodenum, arising from Brunner’s gland hamartoma / hyperplasia, resected by ESD (Endoscopic Submucosal Dissection).

Gastric Type Adenocarcinoma with Fundic Gland Differentiation in the Duodenum Resected by ESD (Endoscopic Submucosal Dissection)