Variable Endoscopic Findings and Clinicopathological Characteristics of Borrmann Type 4 Advanced Gastric Cancer

Chang, Ji Young; Shim, Ki Nam; Tae, Chung Hyun; Choe, A Reum; Moon, Chang Mo; Kim, Seong Eun; Jung, Hye Kyung; Jung, Sung Ae

Abstract

BACKGROUND/AIMS
Borrmann type 4 advanced gastric cancer (AGC) is difficult to diagnose. There are no typical endoscopic findings. Endoscopic biopsies have a high false negative rate because Borrmann type 4 AGC frequently resides below the submucosal cells from which it develops. The aim of this study was to investigate the endoscopic findings of Borrmann type 4 AGC in order to improve diagnosis rates.
MATERIALS AND METHODS
A total of 24 patients with pathologically proven Borrmann type 4 AGC at the Ewha Womans University Medical Center between January 2008 and May 2013 were included. We divided the cases according to their distinguishing endoscopic findings. The diagnostic yield for endoscopic biopsies was evaluated.
RESULTS
The most common endoscopic findings were cases with Bormann type 4 AGC like lesions (diffuse infiltrative, n=10), followed by Bormann type 3 AGC like lesions (ulceroinfiltrative, n=9), Borrmann type 2 AGC like lesions (ulcerofungating, n=4) and early gastric cancer like lesion (n=1). Among the 23 cases in which endoscopic biopsies was performed, the diagnostic yield for the first endoscopic biopsy was 87.0% (n=20). All of the second endoscopic biopsies failed to diagnose the malignancy.
CONCLUSIONS
The endoscopic findings of Borrmann type 4 AGC are atypical and diverse. In cases where negative results are accompanied by a malignant impression, further meticulous evaluation should be performed with careful targeting.