Prognosis of early mucinous gastric carcinoma

Gastric cancer with calcifications: A case report

BACKGROUND

Mucinous gastric carcinoma (MGC) is a rare histological type of gastric carcinoma. Calcifications, seen on imaging and histopathological preparations, and which are infrequent in other types of gastric carcinoma, are characteristic of MGC. We present a patient with MGC with calcifications of the gastric wall and describe the computerized tomography (CT) features of the lesion and changes in the calcifications before and after chemotherapy.

CASE SUMMARY

A 61-year-old man was admitted to our hospital in May 2020 because of a large, tender abdominal mass. Abdominal CT showed diffuse, irregular thickening of the gastric walls, with miliary and punctate calcifications. There were metastases to the perigastric and retroperitoneal lymph nodes and also peritoneal seeding. Histological examination of a specimen obtained by endoscopic biopsy showed poorly differentiated calcified signet-ring cell gastric cancer. The patient was clinically staged with T4N+M1 disease. He was treated with docetaxel, cisplatin, and fluorouracil as first-line therapy, irinotecan combined with S-1 as second-line chemotherapy, and programmed cell death protein 1 as third-line therapy. The patient underwent a total of nine cycles of chemotherapy. Follow-up CT scans every 3 mo showed continually increasing calcifications. As of this writing, the patient has survived almost 1 year.

CONCLUSION

In this case report, we describe the histopathological and imaging characteristics of a patient with gastric cancer receiving chemotherapy. Multiple punctate calcifications were seen, which gradually increased during chemotherapy. Several possible mechanisms for the calcifications are described, but further research is needed. Future findings may lead to new approaches for the evaluation and treatment of such tumors.

Clinical Outcomes of Mucinous Gastric Carcinomas Compared with Non-mucinous and Signet Ring Cell Carcinomas

Background/Aims

This study examined the clinical features and prognosis of patients with mucinous gastric carcinoma (MGC), non-mucinous gastric carcinoma (NMGC), and signet ring cell gastric carcinoma (SRC).

Methods

A retrospective cohort study was performed, enrolling 65 patients with MGC from January 2007 to December 2016. During the same period, 1,814 patients with histologically proven gastric cancers underwent curative or palliative operations. One hundred and ninety-five NMGC patients were selected as the 1:3 age- and sex-matched control groups. In addition, 200 SRC patients were identified. This study evaluated the demographic features of the patients, pathologic features of the tumor, and the predictive factors, such as the recurrence-free survival and overall survival.

Results

The recurrence rates were significantly high in MGC than in NMGC or SRC (both p<0.01). The proportion of early gastric cancer was lower in the MGC group than in the other groups (p<0.01). In addition, metastatic lymph nodes were found more frequently in the MGC group (p<0.01), and the proportion of initial pT4, M1 stage, was highest in the MGC group. The recurrence-free survival and overall survival in the MGC group were significantly lower than those in the NMGC or SRC. Subgroup analysis showed that patients with the same American Joint Committee on Cancer (AJCC) stage of each cancer group showed a similar prognosis.

Conclusions

MGC frequently presents an advanced stage with an unfavorable prognosis compared to NMGC or SRC. On the other hand, MGC of the same AJCC stage had a similar prognosis to NMGC and SRC.

Mucinous adenocarcinoma and non-mucinous adenocarcinoma: differing clinicopathological characteristics and computed tomography features in gastric cancer

Mucinous gastric carcinoma (MGC) is a rare histological subtype of gastric cancer. The clinicopathological characteristics and CT features of MGC remain controversial. This study aimed to determine the clinicopathological characteristics and CT features of MGC. We reviewed 62 patients with MGC and 104 patients with non-mucinous gastric carcinoma (NMGC), pathologically confirmed between 2003 and 2015. There are significant differences in some clinicopathological characteristics and CT features between MGC and NMGC. NMGC occurs preferentially in males and more frequently in the lower third of the stomach. Patients with MGC were characterized by larger tumor size, more advanced tumor stages (II and III) and fewer lymphatic invasions. Layered enhancement (83.3%) was the main pattern of MGC, while the most common pattern in NMGC was homogeneous enhancement (52.6%), followed by heterogonous enhancement (34.6%). The degree of enhancement of the inner layer in MGC was significantly higher than in NMGC (ΔCT of portal venous phase: 54.57 Hu vs. 47.19 Hu, P = 0.034), while the middle or outer layer in MGC was significantly less enhanced (ΔCT of portal venous phase: 19.07 Hu vs. 33.09 Hu, P <0.001). Calcifications were more common in MGC (P <0.001). ROC curves revealed that the most effective variables in distinguishing MGC and NMGC were ΔCT of the middle or outer layer in the arterial phase (AUC=0.774) and portal venous phase (AUC=0.774), followed by the attenuation value of the middle or outer layer in the unenhanced phase (AUC=0.763). Calcifications had a high specificity (98.7%) in the diagnosis of MGC. The accuracy (86.1%), sensitivity (83.3%) and specificity (87.2%) of layered enhancement in diagnosing MGC were all high. Therefore, MGC was more likely to have larger tumor size and more advanced tumor stage (II and III) than NMGC. The thicker gastric wall, layered enhancement pattern and calcification were highly suggestive CT features for differentiating MGC from NMGC.

Prognostic Impact of Different Histological Types on Gastric Adenocarcinoma: a Surveillance, Epidemiology, and End Results Database Analysis

The clinicopathological characteristics and prognosis of gastric mucinous adenocarcinoma (MAC) and signet ring cell carcinoma (SRC) are still controversial. We designed our study to evaluate the clinicopathologic features and prognosis of MAC, SRC and ordinary gastric adenocarcinoma (OGAC) by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. The 5-year overall survival (OS) of patients with SRC was significantly lower than that of patients with MAC (P = 0.001) and OGAC (P < 0.001), and there was no significant difference in 5-year OS between MAC and OGAC (P = 0.804). Furthermore, there were no significant differences of 5-years OS among these three groups at stage I, II and III (all P > 0.05) and no significant difference between MAC and OGAC at stage IV (P = 0.110). Patients in SRC group had significantly worse survival than those in MAC and OGAC at stage IV (both P = 0.008), with 5-year OS of 3.3%, 5.8%, and 5.8%, respectively. However, the histological type was not found to be an independent prognostic factor of gastric cancer according to the multivariate analysis with Cox regression.

The Clinicopathological Features and Long-Term Survival Outcomes of Mucinous Gastric Carcinoma: a Consecutive Series of 244 Cases from a Single Institute

BACKGROUND AND OBJECTIVES

Mucinous gastric carcinoma (MGC) is a rare kind of malignancy with unclear prognosis. This study aims to assess the clinicopathological features and prognosis of MGC.

METHODS

We retrospectively analyzed a consecutive series of 244 MGC patients who underwent radical gastrectomy with D2 lymphadenectomy, and compared the data with 260 gastric signet ring cell carcinoma (SRC) patients.

RESULTS

The univariate survival analysis showed that the surgical types, diameter of the primary tumor, the Borrmann type, pathological depth of tumor invasion (pT), pathological number of metastatic lymph node (pN), pathological tumor lymph metastasis (pTNM), and vascular invasion were all significant predictors of survival (all P < 0.05). The multivariate survival analysis revealed that the diameter of the tumor, the Borrmann type, pT, pTNM stage, and vascular invasion as an independent predictive factor of survival (all P < 0.05). Compared with the SRC group, the MGC group had more male patients, more elder patients, larger tumor diameter, more T3 and T4 invasion to the gastric wall, more patients with metastatic lymph nodes, more pTNM stage III, and less Borrmann type 1. The overall survival rate of patients with MGC was significantly lower than that of patients with SRC (P < 0.001).

CONCLUSIONS

MGC was an aggressive malignancy which had unique clinicopathological features.