Superficial spreading type of early gastric cancer

Superficial spreading type of early gastric cancer coexisting with multiple hyperplastic polyps

We encountered a rare case that involved the superficial spreading type of early gastric cancer coexisting with multiple hyperplastic polyps. An 81-year-old Japanese woman with a history of Helicobacter pylori infection was diagnosed with gastric cancer (cT1bN0M0), which presented as a wide, nodular, aggregated protrusion that was associated with multiple pedunculated and sessile polyps. Distal gastrectomy was performed, and the resected specimen involved an 8 cm × 4 cm nodular aggregated protruding lesion and 15 polyps that were 2-20 mm in size. Histopathological examination revealed that the nodular aggregated protruding lesion was a mucosal adenocarcinoma and that the multiple polyps were hyperplastic. The coexistence of multiple hyperplastic polyps and mucosal adenocarcinoma with nodular aggregated protrusions suggested that the mucosal adenocarcinoma had developed from a fusion of multifocal hyperplastic lesions. This may have occurred via a hyperplasia-carcinoma sequence related to the Helicobacter pylori infection. The superficial spreading type of early gastric cancer has a potential developed from a fusion of multifocal hyperplastic polyps.

Endoscopists' view on superficial spreading type of early gastric cancer--endoscopic resection or surgery?

OBJECTIVE

The superficial spreading type of early gastric cancer (EGC) possesses unique features different from other types of EGC. We aimed to elucidate the clinicopathological features of superficial spreading type of EGC.

MATERIAL AND METHODS

We analyzed 1455 EGC lesions from 1398 patients who had undergone surgical treatment at Samsung Medical Center from 2000 to 2002. Then the clinicopathological features of 224 superficial-spreading EGC lesions (15.4%) was compared to that of 1231 lesions of a common type of EGC.

RESULTS

In the superficial spreading type of EGC, the incidence of undifferentiated type and submucosal invasion were higher than those of common type of EGC (55.4 vs 38.0%, p < .01 and 58.5 vs 37.8%, p < .01, respectively). Lymph node metastasis and lymphovascular invasion were more frequent in superficial spreading type than in common type of EGC (19.2 vs 7.6%, p < .01 and 15.2 vs 7.4%, p < .01, respectively). There was no difference in recurrence rate or 5-year survival rate between the two groups.

CONCLUSION

Considering higher risk of submucosal invasion and lymph node metastasis in superficial spreading type, a careful consideration should be done before the application of endoscopic resection to the superficial spreading type of EGC.

Clinicopathological properties of the superficial spreading type early gastric cancer

INTRODUCTION

We investigated differences in characteristics between the superficial spreading type early gastric cancer (EGC) characterized by a wide and superficial extension and the common type EGC.

PATIENTS AND METHODS

Between 1982 and 2008, we retrospectively reviewed clinical reports of patients with the EGC treated at Kochi Medical School.

RESULTS

Sixty-one patients (9.6%) out of 646 patients had the superficial spreading type EGC. The occurrences of diffuse type histology and lymph node metastasis were significantly greater in the superficial spreading type than in the common type. The incidence of EGC confined to the mucosa was significantly greater in the lymph node-positive superficial spreading type than in the lymph node-positive common type.

CONCLUSIONS

In patients with the superficial spreading type EGC, lymph node metastasis was more prominent regardless of the degree of tumor invasion. Therefore, appropriate extensive lymph node dissection and wide surgical resection are required for the curative resection of the superficial spreading type EGC.

Clinicopathological features of early gastric cancer with duodenal invasion

The incidence of early gastric cancer (EGC) with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management. A Medline search was performed using the keyword “early gastric cancer” and “duodenal invasion”. Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors > 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor. There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum. The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is > 60 mm, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

Does tumor size have an impact on gastric cancer? A single institute experience

PURPOSE

The present study investigated the prognostic significance of tumor size in gastric carcinoma patients.

METHODS

Nine hundred seventy-three gastric carcinoma patients who underwent curative gastrectomy were included and hospital records were reviewed to determine the relationship between tumor size and survival.

RESULTS

First, the patients were divided based on the mean value of the tumor size in respective stages to control selection bias. Only in stages I and III was tumor size a significant independent prognostic factor. Second, we analyzed the appropriate cutoff value for the large tumor. The minimum criterion for a large tumor, which was determined by the receiver-operating characteristic curve for cancer-related death, was 3.5 cm. There were significant differences between patients with large and small tumors with respect to depth of invasion, number of lymph node metastasis, and stage of disease.

CONCLUSIONS

Tumor size serves as an indicator of prognosis in gastric cancer patients and a tumor size of 3.5 cm can be used as a significant lower limit of standard size criterion.

Clinicopathological characteristics of superficial spreading type early gastric cancer

BACKGROUND AND OBJECTIVES

Superficial spreading type early gastric cancer is characterized by its atypical growth pattern and occasionally indistinct tumor margin. Because it is a rare form of early gastric cancer, the clinicopathological details are not apparent. The aim of this study was to clarify the clinicopathological features of the superficial spreading type of early gastric cancer.

METHODS

A retrospective study was conducted in 1,062 surgically resected patients with early gastric cancer. Hospital records were compared between patients with superficial spreading type early gastric cancer and those with more common types of early gastric cancer.

RESULTS

Sixty-nine patients (6.9%) had superficial spreading lesions. The male to female ratio was 1.2:1. The most frequent histological type was signet-ring cell carcinoma (32%). The distinguishing histopathological features were submucosal invasion (67%), lymphatic invasion (32%), and lymph node metastasis (30%). There were discrepancies in tumor area between surgical findings and pathological diagnosis in 24 patients (35%) with superficial spreading type. More extensive lymph node dissection was performed and all patients survived in the group with superficial spreading lesions.

CONCLUSIONS

The most appropriate treatment for the superficial spreading type of early gastric cancer is wide surgical resection with extensive lymph node dissection.

Superficially spreading cancer of the stomach

BACKGROUND

Superficially spreading cancer (SSC) of the stomach is rare and extends widely along the mucosa or submucosa of the stomach. This study was conducted to clarify the clinicopathologic characteristics and prognosis of patients with SSC.

METHODS

SSC was defined as a tumor invading the mucosa or submucosa and measuring > or =5 cm in size. The clinicopathologic findings and outcomes of 36 patients with SSC were compared with those of 300 patients with early gastric cancer (EGC) measuring < or =5 cm and 271 with advanced gastric cancer measuring > or =5 cm.

RESULTS

SSC was significantly different from ordinary EGC in tumor size, frequency of lymph node metastasis, lymphatic invasion, venous invasion, and stage II, III, and IV disease. The frequency of serosal invasion, lymph node metastasis, and lymphatic and venous invasions in cases of SSC was significantly lower than with advanced gastric cancer. Although tumor size of SSC evaluated before operation was smaller than that on the resected specimen, the 10-year survival rate was not different between SSC and ordinary EGC.

CONCLUSIONS

SSC was characterized by high frequency of lymph node metastasis and preoperative underestimation of tumor size. SSC should be treated by a gastrectomy and lymphadenectomy with sufficient resection margin.