Texture and Color Enhancement Imaging Highlights Gastric Adenocarcinoma of the Fundic Gland Type

A 68-year-old woman was referred to our hospital for the examination and treatment of gastric tumor. Esophagogastroduodenoscopy (GIF-EZ1500 with EVIS X1 video system; Olympus Medical Systems, Tokyo, Japan) showed a reddish, submucosal, tumor-like elevated lesion, located in the fornix on white light imaging (Figure A). Indigo carmine spraying revealed a mild elevated lesion with dilated vessels on the smooth surface (Figure B). Dilated vessels with branch architecture were highlighted on magnifying endoscopy with texture and color enhancement imaging (TXI) mode 1 after indigo carmine spraying (Figure C). Laparoscopic endoscopic cooperative surgery was performed for the lesion for biopsy and endoscopic diagnosis. Histological examination showed the lesion to be adenocarcinoma of the fundic gland type (GA-FG), pT1a (M), ly0, v0, pHM0, pVM0 (Figure D). GA-FG is a rare gastric adenocarcinoma, and its endoscopic features are reported to be whitish submucosal tumor composed of branching dilated vessels. TXI is an image-enhanced endoscopy that enhances brightness, surface irregularities, and subtle color changes. The magnifying images with TXI after indigo carmine spraying offered here should provide a clear illustration of how TXI may be effectively used to highlight GA-FG lesions and serve as a benchmark for future investigations.