Key Clinical Message
During endoscopy, a light purple flat lesion suddenly appeared at the
antrum and the lesion disappeared subsequently. This is an unusual
reversible color change that is associated with blood flow, and that
must be differentiated from neoplasia.
A 63-year-old man with heart failure underwent
esophagogastroduodenoscopy. The patient had not receivedHelicobacter pylori eradication therapy and results of serum
antibody test were negative. Endoscopy revealed no gastric lesion upon
initial scope insertion (Figure 1A ). During observation, an
approximately 25-mm diameter, light-purple-colored flat lesion appeared
at the antrum’s greater curvature (Figure 1B, 1C ). Magnifying
narrow-band imaging revealed a regular microsurface and microvascular
pattern (Figure 1D ). The lesion subsequently faded upon slight
deflation of the stomach (Figure 1E ), but reappeared upon
reinflation (Figure 1F ).
The lesion was well-demarcated and flat. Biopsies of both the lesion and
surrounding mucosa were performed to rule out neoplasm.
Hematoxylin-and-eosin-staining of the lesion revealed mostly normal
fundic glands; however, the gland density and mucosal thickness were
slightly decreased compared to the surrounding mucosa (Figure
2 ). CD31 staining revealed little remarkable findings of vascular
density. Computed tomography revealed no masses compressing gastric
walls. Although there have been previous reports on evaluation of
gastric blood flow,1,2 investigations on
real-time color changes in gastric lesions are rare. This study shows
unusual reversible color change in a gastric lesion associated with
slight blood flow changes and reflecting a small focal atrophic change
which must be differentiated from neoplastic lesions.