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This case report describes two atypical early differentiated gastric-type adenocarcinomas showing mixed features of foveolar epithelial, mucous neck cell, chief cell, and parietal cell types, ultimately diagnosed as a special variant. Endoscopic findings, histopathology, and immunohistochemical profiles are detailed, emphasizing diagnostic challenges and implications for classification, surveillance, and treatment decisions.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/two-cases-of-helicobacter-pylori-negative-mixed-early-gastric-tumors-case-report/354468/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/two-cases-of-helicobacter-pylori-negative-mixed-early-gastric-tumors-case-report/354468.png","ImageObject",300,407,{"name":92,"@type":93},"Guten tag","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-24","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What makes H. pylori-negative early gastric cancer difficult to diagnose?","Question",{"text":112,"@type":113},"It is associated with challenges in endoscopic detection, pathological diagnosis, and differentiation from conventional categories, especially when morphology is ambiguous.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What did the two cases show in terms of tumor features?",{"text":117,"@type":113},"Both cases were atypical early differentiated gastric-type adenocarcinomas with mixed features across foveolar epithelial, mucous neck cell, chief cell, and parietal cell types.",{"name":119,"@type":110,"acceptedAnswer":120},"How can recognizing mixed-cell-type adenocarcinomas affect clinical management?",{"text":121,"@type":113},"Recognition can expand pathological classification, influence endoscopic surveillance strategies, and guide treatment decisions such as the extent of endoscopic resection or lymph node dissection.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},354468,1790215780,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":14,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},687212321768,"https://ap-avatar.wpscdn.com/avatar/a0010bdbe886d2fe77?x-image-process=image/resize,m_fixed,w_180,h_180&k=1789897067658708522","TYPE Case Report  \nPUBLISHED 26 June 2026  \nDOI 10.3389/fmed.2026.1755704  \nOPEN ACCESS  \nEDITED BY  \nKhek Yu Ho,  \nNational University of Singapore, Singapore  \nREVIEWED BY  \nFlávio Ramos, Endodiagnostic, Brazil Mei Yang,  \nThe Third People’s Hospital of Chengdu, China  \n*CORRESPONDENCE  \nLiyan Wang  \n [168wangliyan@163.com](168wangliyan@163.com)[ ](168wangliyan@163.com)Xuhua Xiao  \n [260810132@qq.com](260810132@qq.com)  \n†These authors have contributed equally to this work  \nRECEIVED 27 November 2025  \nREVISED 24 April 2026  \nACCEPTED 04 June 2026  \nPUBLISHED 26 June 2026  \nCITATION  \nLuo X, Yi X, Fu H, Ye L, Huang B, Qin E, Li B, Xiao X and Wang L (2026) Two cases of Helicobacter pylori negative mixed early gastric tumors:  \ncase report.  \nFront. Med. 13:1755704 .  \ndoi: 10.3389/fmed.2026.1755704  \nCOPYRIGHT  \n© 2026 Luo, Yi, Fu, Ye, Huang, Qin, Li, Xiao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nTwo cases of Helicobacter pylori negative mixed early gastric tumors: case report  \nXingting Luo 1†, Xiaoyuan Yi 1†, Haixiao Fu 1, Liang Ye 2, Bin Huang 1, En Qin 1, Bin Li 1, Xuhua Xiao 1* and Liyan Wang 1*  \n1Digestive Department, The Affiliated Hospital of Guilin Medical University, Guilin, China, 2Department of Gastroenterology, Affiliated Liuzhou People Hospital of Guangxi Medical University, Liuzhou, China  \nEarly 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.  \nKEYWORDS  \ncase report, early gastric cancer, gastric mucous neck cell, gastric phenotype, Helicobacter pylori negative, mixed type  \nIntroduction  \nHelicobacter pylori is the most important independent risk factor for the development of gastric cancer through the Correa cascade of gastric malignancy. Approximately 90% of gastric cancers are associated with H. pylori infection ( 1) . With improvements in sanitary conditions and increased emphasis on H. pylori eradication therapy, the rate ofH. pylori infection has significantly declined (2). It can be anticipated that the incidence of H. pylori-negative gastric cancer will increase relatively. Nevertheless, H. pylori-negative gastric cancer remains relatively rare compared t","cbCaisZPQdld7tXC","https://ap.wps.com/l/cbCaisZPQdld7tXC","pdf",3752837,"English","# Introduction\n## Helicobacter pylori as a risk factor and the role of H. pylori-negative gastric cancer\n# Case 1\n## Clinical presentation and diagnostic testing\n## Endoscopic findings and classification\n# Case 2\n## Clinical presentation and diagnostic testing\n## Endoscopic findings and classification\n# Discussion\n## Diagnostic challenges and implications for classification, surveillance, and treatment","[{\"question\":\"What makes H. pylori-negative early gastric cancer difficult to diagnose?\",\"answer\":\"It is associated with challenges in endoscopic detection, pathological diagnosis, and differentiation from conventional categories, especially when morphology is ambiguous.\"},{\"question\":\"What did the two cases show in terms of tumor features?\",\"answer\":\"Both cases were atypical early differentiated gastric-type adenocarcinomas with mixed features across foveolar epithelial, mucous neck cell, chief cell, and parietal cell types.\"},{\"question\":\"How can recognizing mixed-cell-type adenocarcinomas affect clinical management?\",\"answer\":\"Recognition can expand pathological classification, influence endoscopic surveillance strategies, and guide treatment decisions such as the extent of endoscopic resection or lymph node dissection.\"}]","Two cases of Helicobacter pylori negative mixed early gastric tumors - case report | PDF",1790110760,18]