Gastritis cystica profunda: a case report and literature review

Gastric cystica profunda (GCP) is a rare disease characterized by multiple cystic lesions in the mucosa and/or submucosal layer. Usually, GCP occurs in stomachs that have previously been operated on. If there is no postoperative pathological results, it is challenging to diagnose GCP based on nonspecific clinical symptoms and imaging findings. This report aimed to provide a comprehensive overview of all cases of GCP reported to date. A comprehensive literature search was conducted for all reported GCP cases between 1972 and 2014. The keywords searched included "gastritis cystica profunda", "submucosal cysts of the stomach", and "heterotopic submucosal gastric glands". One retrospective case from our group was also reported and compared with those from the existing literature. A total of 52 cases were found including 37 (71.2%) men and 15 (28.8%) women (M/F ratio =2.5). The mean age of the patients was 59.9 (range, 39-91) years old. Among the cases, 58.8% (n=30) of lesions were located in the gastric body, 25.5% (n=13) of lesions were located in the fundus, 19.6% (n=9) of lesions were located in the antrum, and 3.9% (n=2) of lesions were located in the cardia, while 1 case was in the prepyloric lesion and 1 case was at the anastomotic site. Of the patients, 52% (n=26) had previously received gastric surgery. The main manifestations of GCP included abdominal pain (n=14, 36.8%) and gastrointestinal bleeding (including hematemesis and melena, n=7, 18.4%). Only 4 of the 52 cases were diagnosed before surgery, and the rest were diagnosed through postoperative histopathologic examination. GCP is difficult to correctly diagnose preoperatively due to its relative rarity and lack of typical clinical symptoms. Histopathological examination should be used for correct diagnosis. Complete surgical removal of the GCP is widely considered as the best treatment option.