Clin Endosc.  2013 Mar;46(2):155-160. 10.5946/ce.2013.46.2.155.

Early Gastric Cancer-Like Advanced Gastric Cancer versus Advanced Gastric Cancer-Like Early Gastric Cancer

• Park HS
• Lee SY
• Hong SN
• Kim JH
• Sung IK
• Park HS
• Shim CS
• Jin CJ

• KMID: 1805297
• DOI: http://doi.org/10.5946/ce.2013.46.2.155

Abstract

BACKGROUND/AIMS
Improvements in the endoscopic evaluation and management of gastric cancer have made it possible to determine the depth of invasion during endoscopic examination. The aim of this study was to elucidate the differences between early gastric cancer (EGC) that resembles advanced gastric cancer (AGC) and AGC that resembles EGC.
METHODS
We retrieved cases of EGC-like AGC and AGC-like EGC from consecutive gastric cancers that had been completely resected. The endoscopic diagnoses and clinicopathological findings were analyzed.
RESULTS
AGC-like EGCs were located mainly in the distal part of the stomach, whereas EGC-like AGCs were located mainly in the proximal part of the stomach (p<0.001). Sixty percent of AGC-like EGCs were moderately differentiated adenocarcinomas, while 64% of EGC-like AGCs were poorly differentiated adenocarcinomas (p=0.015). According to Lauren's classification, 68% of AGC-like EGCs were intestinal type, whereas 71% of EGC-like AGCs were diffuse type (p=0.020).
CONCLUSIONS
AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Lauren's diffuse type, and invade deeper than their endoscopic appearance might suggest.

Keyword

Early gastric cancer; Advanced gastric cancer; Gastrointestinal endoscopy

MeSH Terms

Adenocarcinoma
Endoscopy, Gastrointestinal
Stomach
Stomach Neoplasms

Figure

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  Fig. 1 Study flow of our study. Of consecutive gastric cancers that were resected and analyzed for microsatellite instability and mucin phenotype, we retrieved 25 advanced gastric cancer (AGC)-like early gastric cancers (EGCs) and 14 EGC-like AGCs.

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  Fig. 2 An advanced gastric cancer-like early gastric cancer in a 48-year-old man. (A) Endoscopic image shows a huge mass extending from prepyloric antrum to lower-body. Macroscopic appearance shows an irregularly elevated lesion, measuring 8.6×7.1 cm. (B) Histological examination demonstrates submucosal cancer invading down to the deepest submucosal layer (H&E stain, ×12.5).

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  Fig. 3 An early gastric cancer-like advanced gastric cancer in a 69-year-old man. (A) Endoscopic image shows a depressed lesion with irregular margin in the cardia. Macroscopic appearance shows a slightly depressed lesion measuring 2.5×2.5 cm. (B) Histological examination demonstrates invasion confined to the muscularis propria layer (H&E stain, ×12.5).

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  Fig. 4 Locations of advanced gastric cancer (AGC)-like early gastric cancers (EGCs) and EGC-like AGCs. AGC-like EGCs are mostly located in the distal part of the stomach, whereas EGC-like AGCs are mostly located in the proximal part of the stomach (p<0.001).

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