Advanced gastric carcinoma simulating early gastric carcinoma

Eighty-six cases of advanced gastric carcinoma simulating early gastric carcinoma were studied clinicopathologically. Cytophotometric DNA analysis was also performed in 33 cases. Most of these particular carcinomas were of the depressed type on gross inspection. Histologically, the tumors were of diffuse type in 60%. The rate of the carcinomas restricted to within the muscularis propria was 48% and high in comparison with those in conventional advanced gastric carcinomas. There were four main growth patterns: small invasion type (Type A, 43 cases), ulcer-connected type (Type B, 19 cases), vessel permeation type (Type C, six cases), and diffusely infiltrative type (Type D, 13 cases). There was a relationship between growth patterns, lymph node metastasis, and prognosis: Types A and B had a small percentage of lymph node metastasis and a good prognosis, whereas Types C and D a high percentage and a poor prognosis. DNA analysis revealed that two thirds of the examined cases showed a low ploidy pattern. The DNA ploidy patterns were concerned with the tumor growth pattern: high-ploidy cases were rarely seen in Types A and B yet were frequent in Types C and D. The 5-year survival rate was 73%, but results were poor in cases of tumors with blood vessel permeation, in those with lymph node metastasis, in those with the Type D or C growth patterns, and in those with high DNA ploidy pattern. Since these carcinomas can be understaged endoscopically and by gross examination, a precise study of the surgically excised tissues will aid in making an accurate prognosis.     

Early gastric cancer mimicking advanced gastric cancer.

The clinicopathological features of 37 early gastric cancers mimicking advanced gastric cancer were reviewed retrospectively, and were compared with 596 other early gastric cancers and 126 mp gastric cancers, defined as gastric cancer invading the muscularis propria of the stomach. A greater tumour size (P < 0.005), submucosal invasion (P < 0.005), lymph node and lymph vessel invasion (P < 0.005) and vascular invasion (P < 0.025) were found more frequently in early gastric cancers mimicking advanced gastric cancers than in other early gastric cancers. There were no significant differences in the clinicopathological findings between early gastric cancers mimicking advanced gastric cancers and mp gastric cancers. Patients with early gastric cancers mimicking advanced gastric cancers showed a lower survival rate than patients with other early gastric cancers, but a higher survival than those with mp gastric cancers. The macroscopic appearance of an advanced gastric cancer was an indicator of massive submucosal invasion and lymph node metastasis in early gastric cancer. As early gastric cancers mimicking advanced gastric cancers showed similar clinicopathological findings to mp gastric cancers, these cancers should be treated as mp gastric cancers.     

胃淋巴瘤与胃腺癌的临床病理对比研究

目的 对比研究原发性胃淋巴瘤(primary gastric lymphoma,PGL)与胃腺癌(gastric adenocarcinoma,GA)临床及病理特征,以期增进对该疾病的临床诊治.方法 对49例原发性胃淋巴瘤和200例胃癌患者比较其年龄、发病时间、临床症状、肿块部位、内镜及大体分型、幽门螺杆菌(Helicobacter pylori,Hp)感染及组织病理学等临床资料,并详细分析12例早期胃淋巴瘤的临床病理资料.结果 49例PGL和200例GA组患者,均表现为腹痛、腹部不适和上消化道出血等非特异性症状.PGL多发于胃体及胃窦,病灶常为多发溃疡或巨大结节,GA组病灶以胃窦部为主,常呈单发溃疡;PGL组的Hp感染率显著高于胃癌组(P＜0.05);PGL术前诊断率显著低于GA组(P＜0.05).12例早期PGL患者中,8例为Ⅱc型病变,治疗效果较好.结论 内镜检查示胃黏膜有多发糜烂溃疡时,应考虑PGL可能.早期PGL确诊后通过手术、化疗或根除Hp治疗,预后良好.     

胃神经内分泌癌与胃神经内分泌瘤及胃腺癌的CT特征及鉴别

目的 探讨胃神经内分泌癌(G NEC)与胃神经内分泌瘤(G NET)及胃腺癌(G ADC)的CT特征,为临床诊治提供参考。方法 选取2014年1月至2018年9月于南京医科大学第一附属医院老年消化科就诊的G NEC、G NET及G ADC患者各15例，分别为G NEC组、G NET组及G ADC组，对多个CT特征进行评估,以鉴别G NEC与G NET及G ACD的影像学差异。结果 3组中存在差别的CT特征有肿瘤最大径(P=0023)、肿瘤位置(贲门、胃底及胃体为上部,胃体中下部及胃窦为下部, P=0020)、病灶数量(单发、多发及散发,P=0003)、肿瘤边缘是否清晰(P<0001)、黏膜是否完整(P<0001)、淋巴结是否转移(P<0001)、转移淋巴结最大径(P=0008)和有无淋巴结的坏死(P=0006);随后进行G NEC与G NET两组间比较,经单因素分析发现G NEC的病灶更大［(472±173)cm比(208±102)cm,P<0001)］,位于胃体中下部及胃窦的概率更高(600％ 比 133％, P=0021),单发病例更多(100％ 比667％, P=0042),更易发生淋巴结转移(933％ 比 200％,P=0001)。G NEC和G ADC两组间的CT特征的单因素分析显示,G NEC的转移淋巴结直径比G ADC的大［(182±069)cm 比(123±065)cm,P=0045］,G NEC的肿瘤边缘较G ADC清晰(600％ 比0, P=0001), G NEC的肿瘤黏膜较G ADC肿瘤黏膜完整(533％ 比667％, P=0014)。结论 CT的特征有助于G NEC与G NET及G ADC的诊断。     

Patterns of gastric atrophy in intestinal type gastric carcinoma

BACKGROUND: Multifocal atrophic gastritis (MAG) is currently considered a precancerous lesion leading to intestinal type gastric carcinoma. The current study aimed to describe the topography of atrophy in stomachs with early gastric carcinoma. METHODS: Resected stomachs from patients with intestinal type gastric carcinoma were routinely processed, sectioned (an average of 108 sections/stomach), and stained with a triple stain. Sections were scored on a visual analog scale for Helicobacter pylori and intestinal metaplasia. The type of epithelium (antral, oxyntic, transitional) was recorded. Atrophy was defined as the loss of normal glandular components and included intestinal metaplasia and/or pseudo-pyloric metaplasia of the corpus. Pseudo-pyloric metaplasia was identified by the presence of pepsinogen I in mucosa that was topographically corpus but phenotypically antrum. RESULTS: Sixteen stomachs with intestinal type gastric carcinoma were examined. In none of the specimens examined was MAG (independent foci of atrophy) identified. In the majority (88%), atrophy was present as a continuous sheet. Islands of intestinal metaplasia (multifocal intestinal metaplasia) were present within a sheet of pseudo-pyloric metaplasia. A few specimens (12%) had a non-atrophic corpus with almost total replacement of antral epithelium with intestinal metaplasia. Multifocal dysplasia distant from the original tumor was found both in areas with and without intestinal metaplasia. CONCLUSIONS: Contrary to popular belief, atrophy in intestinal type gastric carcinoma is not present as independent foci, but rather as a continuous sheet. Previous studies failed to identify pseudo-pylori metaplasia as a marker for atrophy.     

Changes in gastric mucosa that antedate gastric carcinoma.

Endoscopic biopsy specimens of the gastric mucosa from 13 patients who were found at follow-up examination to have gastric carcinoma were compared for abnormal histologic features, type of intestinal metaplasia, and presence of immunoreactive carcinoembryonic antigen (CEA), with specimens from 40 tumor-free controls. Villus-like changes and angular infolding, cytologic nuclear pleomorphism, distinct nuclear border, irregular thickness of the nuclear membrane, irregular chromatin clumping, prominent nucleoli, and distinct nucleoli were manifestations of the carcinoma group. Angular infolding, distinct nuclear border, irregular thickness of the nuclear membrane, and distinct nucleoli were also observed in the latent stage before detection of carcinoma. The individual features, however, lacked specificity. Histochemically, a IIB subtype of intestinal metaplasia, and immunoreactive CEA in the cytoplasm of foveolar epithelium appeared exclusively in the patients with carcinoma. These findings indicate that the gastric epithelium of patients with gastric carcinoma tends to be morphologically and histochemically abnormal even before the recognition of classical dysplasia. This can be described as abnormal epithelium and is believed to provide the soil on which gastric carcinoma develops.     

Prognostic effects of the gastric mucosal microbiota in gastric cancer

Gastric cancer (GC) is one of the most common malignant tumors with a high incidence and mortality. Microbiota play a significant role in human health and disease. We aimed to investigate the prognostic value of the gastric microbiota in different stomach microhabitats. We used our previously published 16S rRNA gene sequence data. We retrospectively enrolled a cohort of 132 patients with GC with complete prognostic information and selected 78 normal tissues, 49 peritumoral tissues, and 112 tumoral tissues for microbiota analysis. Patients with different prognoses showed different gastric microbiota compositions and diversity. The association network of the abundant gastric microbiota was more complicated in patients with poor prognoses. In the peritumoral microhabitat of patients with good prognoses, Helicobacter was significantly increased, whereas Halomonas and Shewanella were significantly decreased relative to that in the peritumoral microhabitat of patients with poor prognoses. PiCRUSt analysis revealed that the peritumoral microbiota had more different Kyoto Encyclopedia of Genes and Genomes pathways than did the tumoral and normal microbiota. This study evaluated the long-term prognostic value of the gastric mucosal microbiota in patients with GC. These findings suggested that the characteristic alterations of the gastric mucosal microbiota may be markers for clinical outcomes in these patients.     

Sonic hedgehog expression in gastric cancer and gastric adenoma

Hedgehog protein is essential to gastrointestinal tract development, and disruption of the hedgehog signaling pathway is associated with gastrointestinal tumorigenesis. Here, we analyzed the degree of hedgehog expression in gastric cancer and precancerous tissue. From August 2005 to May 2006, 52 gastric cancers and 16 gastric adenomas were obtained from surgically or endoscopically resected specimens. Immunohistochemical staining using sonic hedgehog (Shh) antibody was performed in cancerous and noncancerous tissue portions. Hedgehog expression was assessed based on the summed scores of the intensity and proportion of Shh staining. According to Lauren's classification, Shh expression was stronger in the intestinal type than in the diffuse type (p<0.001). Although Shh expression was not related to the location, size, metastatic status, or mucin phenotype of the gastric cancer, the expression was stronger in the tubular type of gastric cancer than in the mucinous and signet-ring cell types (p=0.001). Shh expression was stronger in gastric adenoma than in the diffuse-type gastric cancer (p<0.001), but revealed no difference with that of the intestinal-type gastric cancer (p=0.30). Shh expression was strongest in all types of intestinal metaplasia of noncancerous tissues. Shh expression is related to the intestinal type of gastric cancer. The stronger Shh expression in intestinal metaplasia and gastric adenoma indicates that hedgehog protein is involved at an early phase of gastric carcinogenesis.     

Risk of gastric cancer among patients with gastric intestinal metaplasia

Plenty of studies have assessed the association between intestinal metaplasia (IM) and gastric cancer risk, while the results were inconsistent. We aimed to assess the risk of gastric cancer among patients with IM. Systematic literature searches were conducted in PubMed, Embase and Cochrane databases. Baseline characteristics and outcomes from the included studies were extracted independently by two investigators. Either a fixed‐effects or a random‐effects model was used to composite the pooled OR for gastric cancer risk. Finally, a total of 21 studies, which comprised 402,636 participants and 4,535 gastric cancer patients, were finally included in the current meta‐analysis. Compared with those participants without IM, IM patients were at a higher risk of gastric cancer (pooled OR = 3.58, 95% CI 2.71–4.73). We observed that incomplete IM (pooled OR = 9.48, 95% CI 4.33–20.78) but not complete IM (pooled OR = 1.55, 95% CI 0.91–2.65) was significantly associated with a higher gastric cancer risk. Besides, it appeared that gastric cancer risk was higher among patients with IM in the corpus (pooled OR = 7.39, 95% CI 4.94–11.06) than those with IM in the antrum only (pooled OR = 4.06, 95% CI 2.79–5.91). And the pooled ORs for gastric noncardia cancer and gastric cardia cancer were 4.98 (95% CI 3.12–7.95) and 1.93 (95% CI 1.15–3.24), respectively. In conclusion, patients with IM were at a higher risk of gastric cancer, especially for incomplete IM and IM in the corpus. The current evidence supports the use of IM subtypes in the surveillance of gastric cancer.     

Cisplatin-induced gastric paresis

Summary A 27 year old male with metastatic testicular carcinoma was treated with cisplatin, vinblastine, and bleomycin (PVB) chemotherapy. After receiving a cumulative dose of 500 mg/m2 of cisplatin, he developed severe nausea and vomiting and had clinical evidence of a cisplatin-induced peripheral neuropathy. His vomiting resolved five weeks after discontinuation of cisplatin. We believe this case represents the first report of gastric autonomic neuropathy induced by cisplatin.     

Primary gastric lymphoma

The pathogenesis of gastric MALT lymphoma starts with accumulation of MALT following infection of the stomach byH. pylori. Rarely this lymphoid infiltrate contains cells with a growth advantage possibly due to a genetic change (trisomy 3?). The result is a monoclonal lymphoproliferative lesion which is responsive toH. pylori driven T-cell help. Because its growth is dependent on the presence of local antigen, gastric MALT lymphoma remains localized for long periods and it is during this phase that the lymphoma can be treated by eradication ofH. pylori. Further genetic changes, as yet uncharacterized may lead to escape from T-cell dependency and ultimately high grade transformation     

胃神经鞘瘤(附26例分析)

目的通过对26例胃神经鞘瘤的回顾性分析,提高对这一罕见疾病的认识.方法对胃神经鞘瘤临床资料,X线、胃镜表现,病理资料,治疗方法并依据现代肿瘤学、外科病理学对其进行分析.结果胃神经鞘瘤临床上以黑便、贫血貌、腹痛多见,可有腹部包块.该病病史体征无特异性,X线、胃镜、B超、CT检查均无特殊征象.术前常误诊为胃平滑肌(肉)瘤、胃溃疡、胃癌.光镜下该肿瘤由雪旺(Schwann)氏细胞构成,免疫组化S-100多呈阳性.26例全部手术.结论胃神经鞘瘤是由胃壁间质中雪旺氏细胞形成的肿瘤,临床罕见.良性多于恶性,男性多发,40岁以上多发.好发于胃体、底,窦部少见.良恶性在发病年龄上无明显差异.良性包膜完整,无核分裂象,无浸润性;恶性无完整包膜,异形性明显,有核分裂象,有浸润性.该病病史、症状、体征特异性不明显,影像学检查均无特殊征象,术前诊断困难,误诊率高.手术为首选疗方法,确诊依赖术后病理,免疫组化和电镜检查对明确具体来源和鉴别诊断有很大帮助.     

Antigen MG7 in gastric cancer and gastric precancerous lesions

Earlydetectionandearlydiagnosisofgastriccancerareessentialtodecreasethemortalityandincreasesurvivalrateofgastriccancer.TheZhuangheregioninLiaoningProvinceisahighriskareaofgastriccancerandanimportantresearchbaseforgastriccancerpreventionandtreatmentinChina[1].AlargescalescreeningofgastriccancerinthisareawascarriedoutbytheCancerInstituteofChinaMedicalUniversitypreviously.Inthepresentstudy,thegastricmucosasamplesfromthescreeningwereusedtoinvestigatethedynamicexpressionofgastriccancer-associat…     

Mucinous gastric carcinomas

BACKGROUND:

Mucinous gastric carcinoma (MGC) is characterized by substantial mucous lakes within tumors and comprises 3% of gastric carcinomas at the authors' institute.

METHODS:

The authors analyzed the clinicopathologic characteristics, mucin gene expression profiles, microsatellite instability (MSI), and status of the human epidermal growth factor receptor 2 (HER‐2) and epidermal growth factor receptor (EGFR) genes in 133 MGCs and compared them with the same variables in nonmucinous gastric carcinomas (NMGCs). In addition, the prognostic implications of clinicopathologic parameters were evaluated.

RESULTS:

Patients who had MGC had deeper invasion (P = .003), more frequent lymph node metastasis (P < .001), more advanced pathologic stage (P < .001), more frequent lymphatic invasion (P < .001), and lower disease‐specific survival rates (P < .0001) than patients who had NMGC. However, a mucinous histology per se was not identified as an independent prognostic factor. Negative mucin 1, cell surface associated (MUC1) status (P < .001); positive mucin 2, oligomeric mucus/gel‐forming (MUC2) status (P < .001); negative mucin 5AC, oligomeric mucus/gel‐forming (MUC5AC) status (P = .036); and negative mucin 6, oligomeric mucus/gel‐forming (MUC6) status (P < .001) were more frequent in MGCs. The frequency of MSI in MGC was not significantly different from that in NMGC. MGCs had a significantly lower incidence of HER‐2 protein overexpression (P = .046), HER‐2 gene amplification (P = .009), and EGFR protein overexpression (P = .017) than NMGCs; and multivariate analysis identified EGFR overexpression as a factor associated with a poor prognosis (P = .047). Patients with MGC who had a predominance of signet ring cells in mucin pools had poorer disease‐specific survival than patients who had MGC with predominant tubular differentiation (P = .017).

CONCLUSIONS:

The clinicopathologic and molecular characteristics of MGCs differed from those of NMGCs. Furthermore, the results indicated that EGFR overexpression and histologic subtyping by predominant tumor cell type in mucin pools may be helpful for predicting clinical outcome in patients with MGC. Cancer 2009. © 2009 American Cancer Society.     

Comparative endoscopic study of primary gastric lymphoma vs. gastric carcinoma

The endoscopic records of 56 patients with primary gastric lymphoma and 120 patients with gastric adenocarcinoma (matched for age and sex) were compared with respect to site, extent, and type of tumor by endoscopy and biopsy results. Diagnosis of lymphoma was suspected on the basis of gross endoscopic appearance in 30 patients with 96% sensitivity. The endoscopic findings that achieved statistical significance in favor of lymphoma were extensive disease involving whole stomach, proximal stomach involvement, extension of tumor into duodenum, and the presence of volcano crater-like ulcers on polypoid lesions. Endoscopic biopsies were positive for lymphoma in 92% patients. Immunoperoxidase staining for leucocyte common antigen was positive in all the 24 patients with lymphoma where it was performed. We conclude that lymphoid origin of the stomach tumor may be suspected in one-half of the cases of primary gastric lymphoma by gross endoscopic findings. Multiple endoscopic biopsies are safe and highly sensitive and specific in the diagnosis of primary gastric lymphoma. © 1994 Wiley-Liss, Inc.     

Does gastric adenocarcinoma develop after the treatment of gastric lymphoma?

Two adult patients with the diagnosis of gastric lymphoma who developed adenocarcinoma of the stomach 8 years after the treatment are presented. Both patients were treated by subtotal gastrectomy followed by irradiation of 4,000–4,500 cGy to the epigastric region and six courses of chemotherapy (vincristine, cyclophosphamide, prednisolone). In our review of the literature, 16 cases of gastric adenocarcinoma following the treatment of gastric lymphoma were found and listed with details. The factors influencing the development of this secondary carcinoma, mainly those treatment related are discussed. The possible role of both radiotherapy and chemotherapy in shortening the latent period for the development of stump carcinoma is emphasized. © 1993 Wiley-Liss, Inc.     

胃癌和胃淋巴瘤的CT表现对比分析

背景与目的:进展期胃癌与胃淋巴瘤的CT表现在鉴别诊断上较困难,均可表现为胃壁增厚、腔内肿块、胃腔狭窄、淋巴结肿大、远处脏器转移等。本研究通过对比胃癌与胃淋巴瘤的CT表现差异,以提高对胃肿瘤,特别是胃淋巴瘤的CT诊断水平。方法:回顾性分析27例进展期胃癌和25例胃淋巴瘤患者的CT表现,观察病变部位、病变大体形态、胃周径侵犯范围、病灶的最大厚度、粘膜是否光整、粘膜皱襞是否增厚、浆膜受侵情况、有无坏死、病变强化程度、强化是否均匀、其他器官受累情况、腹部淋巴结情况。结果:23例(85.2%)胃癌近胃腔表面见"白线"征,门静脉期"白线"区范围较动脉期大;所有胃淋巴瘤患者均未见"白线"征。13例(48.1%)胃癌非"白线"区门静脉期强化程度高于动脉期。所有胃癌患者胃壁侵犯范围均<50%,23例(85.2%)胃淋巴瘤患者胃壁侵犯范围>75%。所有27例(100%)胃癌患者均见胃粘膜溃疡,1例(4%)胃淋巴瘤见胃粘膜溃疡。11例(44.0%)胃淋巴瘤有2个区或以上的胃周淋巴结肿大,8例(32.0%)胃淋巴瘤患者有肾门下腹膜后淋巴结肿大;所有胃癌患者均未见2个区或以上胃周肿大淋巴结,亦未见肾门下腹膜后淋巴结肿大。结论:胃癌与胃淋巴瘤的CT表现各有其特点,包括有无胃粘膜"白线"征、粘膜溃疡、胃壁侵犯范围、胃周肿大淋巴结分布、有无肾门下腹膜后肿大淋巴结等,这些特点对于二者的鉴别诊断具有一定的参考价值。     

Distinction of differentiated type early gastric carcinoma with gastric type mucin expression

BACKGROUND: Intestinal and diffuse gastric carcinomas differ in morphology and growth behavior. Differentiated type gastric carcinoma (DGC), which corresponds roughly with the intestinal type of Lauren, can demonstrate phenotypic properties associated with mucin expression and brush border. However, their clinical significance is controversial. A classification based on mucin phenotype and brush border was performed to determine the clinicopathologic diversity of DGCs in their early stage. METHODS: A total of 120 specimens from 116 DGC patients with definite submucosal invasion were evaluated both macroscopically and histologically. All sections were examined immunohistochemically with human gastric mucin, Muc-2, and CD10 and with mucin histochemically with paradoxical concanavalin A staining and high iron Diamine-Alcian Blue. They were classified into gastric type (G-type), intestinal type (I-type), mixed gastric and intestinal type (M-type), or null type (N-type) phenotypes. The immunoreactivity of E-cadherin and beta-catenin also was investigated to determine the correlation between mucin phenotype and clinicopathologic factors. RESULTS: The G-type phenotype was found to be in contrast to I-type: G-type was an independent factor associated with lymph node metastasis. Significant correlations were observed between the G-type phenotype and the complex type carcinoma found that was histologically: lymphatic invasion, lymph node metastasis, and the abnormal expression of E-cadherin. A significant difference in the proportion of mucin phenotypes between papillary type and tubular type carcinoma was observed. G-type was found to be the predominant phenotype in papillary carcinoma in contrast to tubular carcinoma. CONCLUSIONS: The G-type mucin phenotype and papillary adenocarcinoma should be distinguished from other types of DGCs because of their increased malignant potential in the incipient phase of invasion and metastasis. The significance of G-type and papillary adenocarcinoma should be reflected in the treatment of patients with early stage DGCs, including endoscopic mucosal resection.     

Metachronous gastric MALT lymphoma and early gastric cancer

In a recent paper published in this journal, Copie-Bergman etal. [1] presented four cases of metachronous early gastric cancerdeveloping after gastric MALT lymphoma. In these patients, theyfound (minimal) residual lymphoma in all surgical specimens,suggesting that such patients might have an increased risk