Assessment of Gastric Phenotypes Using Magnifying Narrow-Band Imaging for Differentiation of Gastric Carcinomas from Adenomas

Figure 1

Endoscopic images of gastric carcinomas and adenomas under white-light imaging endoscopy (WLE) and narrow-band imaging with magnifying endoscopy (NBI-ME). WLE was insufficient for definitive diagnosis of carcinomas and adenomas ((a)–(d)). NBI-ME image (e) and schema (i) of A type carcinoma revealed loop-like microvessels enclosed in papillary or granular microstructures. Immunohistochemical staining demonstrated a gastric dominant phenotype. The carcinoma cells were strongly positive for MUC5AC (m). NBI-ME images of AB type carcinoma showed gyrus-like groove structures and a focal white opaque substance ((f), (j)). Immunohistochemical staining demonstrated a gastrointestinal phenotype. CD10 was expressed in the luminal surfaces of the carcinoma tubules (n). NBI-ME images of B type carcinoma ((g), (k)). The lesion showed round or tubular pits surrounded by clear mesh-form microvessels. Histological findings demonstrated intramucosal well-differentiated tubular adenocarcinoma with low-grade atypia. Despite the presence of cells with nuclear atypia similar to adenoma, this tumor presented tortuous and irregular branched glands (o). NBI-ME images of B type adenoma ((h), (l)). The lesion showed tubular pits and a diffuse white opaque substance, leading to unclear mesh-form microvessels. This lesion was histologically determined to be a tubular adenoma (p). There was a consistency of A-B classification under NBI-ME and mucin phenotypes in carcinomas and adenomas.