Gastritis cystica profunda occurring under immunosuppression: A case report of a patient with autoimmune hepatitis
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Published on: February 3, 2012
Hong-Mei He1, Shu-Yan Xu1, Yi-Cun Liu1
1Department of Gastroenterology, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, PR China.
Rationale:
Gastritis cystica profunda (GCP) is a rare gastric submucosal lesion without typical clinical symptoms. Its pathogenesis has not yet been elucidated, and there is no consensus regarding its treatment, which primarily includes surgical and endoscopic methods. Autoimmune hepatitis (AIH) is an inflammatory liver condition characterized by elevated serum immunoglobulin G levels and multiple autoantibodies. Patients with AIH typically require long-term oral immunosuppressive therapy. However, whether immunosuppression accelerates or is correlated with the growth of gastric masses has not been reported.
Patient Concerns:
A 51-year-old woman with AIH on long-term oral immunosuppression was found to have a gastric mass. Rapid growth of the mass was noted after more than 3 years of follow-up, and pathology was suggestive of GCP after endoscopic submucosal dissection.
Diagnoses:
We report the gastroscopic, ultrasonographic, and computed tomography manifestations, as well as the diagnostic and therapeutic procedures, of a case of GCP in a patient with AIH on long-term oral immunosuppression, with the aim of improving clinicians' knowledge of this disease.
Interventions:
As endoscopic ultrasound indicated that the lesion was localized within the mucosal layer, beneath which a tubular anechoic area was observed, we performed endoscopic submucosal dissection to achieve en bloc resection of the lesion.
Outcomes:
Postoperative follow-up revealed that the patient recovered well. The patient in this case report had an incidental finding of gastric body GCP with no previous history of gastric surgery but had a clear history of autoimmune disease and immunosuppressant administration. Therefore, we speculate that GCP may be correlated with immune modulation. Additionally, immunosuppressive agents may contribute to the development of GCP.
Lessons:
Although the pathogenesis of GCP remains unclear, this case suggests that long-term immunosuppressive therapy may accelerate its progression.
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