J Korean Med Sci.  2016 Jun;31(6):873-878. 10.3346/jkms.2016.31.6.873.

Clinicopathologic Similarities of the Main and Minor Lesions of Synchronous Multiple Early Gastric Cancer

• Kim JH
• Jeong SH
• Yeo J
• Lee WK
• Chung DH
• Kim KO
• Chung JW
• Kim YJ
• Kwon KA
• Park DK

• KMID: 2373695
• DOI: http://doi.org/10.3346/jkms.2016.31.6.873

Abstract

The detection rate of early gastric cancer (EGC) is increasing due to improvements in diagnostic methods, but synchronous multiple EGC (SMEGC) remains a major problem. Therefore, we investigated the characteristics of and the correlation between the main and minor lesions of SMEGC. We retrospectively reviewed the medical records of patients with EGC between April 2008 and May 2013. The main lesion was defined as the one with the greatest invasion depth. If lesions had the same invasion depth, the tumor diameter was used to define the main lesion. Of 963 patients who had treatment for EGC, 37 patients with SMEGC were analyzed. The main and minor lesions showed a significant positive correlation of size (r = 0.533, P = 0.001). The main and minor lesions of SMEGC showed the same vertical and horizontal locations at 70.3% and 64.9%, respectively (P = 0.002 and P = 0.002). Macroscopic types were identical in 67.6% (P < 0.001), and 32.4% had identical macroscopic type and location. The main and minor lesions had identical characteristics of invasion depth, presence of lymphovascular invasion (LVI), and differentiation in 78.4%, 83.8%, and 83.8%, respectively. Differentiation, LVI, and invasion depth (microscopic characteristics) were simultaneously the same in 62.2%. The location, macroscopic type, and 3 microscopic characteristics were matched in 27%. The main and minor lesions of SMEGC have similar clinicopathologic characteristics. Therefore, the possibility of SMEGC should not be neglected in cases of EGC, considering an understanding of the characteristics and association of lesions.

Keyword

Stomach; Endoscopy; Gastrectomy; Neoplasms, Multiple Primary, Synchronous

MeSH Terms

Aged
Early Detection of Cancer
Female
Gastrectomy
Gastric Mucosa/pathology
Gastroscopy
Humans
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Retrospective Studies
Stomach Neoplasms/*pathology

Figure

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  Fig. 1 Correlation of tumor size in main and minor lesions of SMEGC. The line indicates a moderate linear relationship of tumor size between the main and minor lesions of SMEGC (r = 0.533, P = 0.001). SMEGC, synchronous multiple early gastric cancer.

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  Fig. 2 The matching characteristics between the main and minor lesions of SMEGC. The main and minor lesions had the same differentiation in 83.8% of cases. Three microscopic characteristics, including differentiation, LVI, and depth of invasion, were the same in 62.2% of the main and minor lesions. Both the three microscopic characteristics and the type were matched in 43.2%. All six factors matched in 27.0%, including the three microscopic characteristics, macroscopic type, and vertical and horizontal location. SMEGC, synchronous multiple early gastric cancer; LVI, lymphovascular invasion; VL, vertical location; HL, horizontal location.

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