Two cases of Helicobacter pylori negative mixed early gastric tumors: case report

Early gastric cancer, which is negative for Helicobacter pylori (H. pylori), is characterized by difficulties in endoscopic detection, pathological diagnosis, and differentiation. With the deepening understanding of gastric tumors, clinically, there has been a gradual discovery of some early gastric cancers that do not fit conventional categories. This article reports two cases of atypical early differentiated gastric-type adenocarcinoma with mixed features of foveolar epithelial type, mucous neck cell type, chief cell type, and parietal cell type, ultimately diagnosed as a special type of early gastric cancer. We detail the endoscopic features, histopathological findings, and immunohistochemical profiles of these cases, highlighting the diagnostic challenges and the importance of recognizing such rare variants. The identification of these mixed-cell-type adenocarcinomas has significant implications, including expanding the current pathological classification of early gastric cancer, modifying existing endoscopic surveillance strategies, and influencing treatment decisions, such as the extent of endoscopic resection or lymph node dissection. Moreover, these findings underscore the need for heightened awareness among pathologists and endoscopists when encountering H. pylori-negative early gastric cancers with ambiguous morphology. By shedding light on this underrecognized entity, our report contributes to more accurate diagnosis and personalized management of early gastric cancer patients.