J Gastric Cancer.  2018 Dec;18(4):400-408. 10.5230/jgc.2018.18.e40.

A Single-Center Experience of Endoscopic Resection for Early Gastric Cancer with Lymphoid Stroma

• Lim H
• Lee JH
• Park YS
• Na HK
• Ahn JY
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Jung HY

• KMID: 2429886
• DOI: http://doi.org/10.5230/jgc.2018.18.e40

Abstract

PURPOSE
This study aimed to evaluate immediate outcomes and clinical courses of patients with early gastric carcinoma with lymphoid stroma (GCLS) who underwent endoscopic resection.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 40 patients (mean age, 56.9 years; 90.0% male) who underwent endoscopic resection and were pathologically diagnosed with GCLS confined to the mucosa or to the submucosa between March 1998 and December 2017.
RESULTS
Forty GCLS lesions in 40 patients were treated using endoscopic resection. Only 4 (10%) patients received diagnosis of GCLS before endoscopic resection. Fourteen (35.0%) lesions were intramucosal cancers and 26 (65.0%) exhibited submucosal invasion. En bloc resection (97.5%) was achieved for all lesions except one, with no significant complications. The complete resection rate was 85.0% (34 of 40 lesions). After endoscopic resection, 17 patients were referred for surgery and underwent gastrectomy with lymph node (LN) dissection because of deep submucosal invasion (n=16) and misclassification as undifferentiated cancer (n=1). No LN metastasis was determined in the specimens obtained during surgery. During a mean follow-up period of 49.7 months for 23 patients without surgical treatment, no regional LN enlargements, distant metastases, or gastric cancer-related deaths were found, although 1 metachronous lesion (undifferentiated adenocarcinoma, follow-up duration: 7 months) was observed.
CONCLUSIONS
In patients with early GCLS, endoscopic resection is technically feasible and has favorable clinical outcomes. Therefore, endoscopic resection might represent an alternative treatment modality in patients with early GCLS with a low likelihood of LN metastasis.

Keyword

Endoscopy; Stomach; Early gastric cancer; Gastric carcinoma with lymphoid stroma

MeSH Terms

Adenocarcinoma
Diagnosis
Endoscopy
Follow-Up Studies
Gastrectomy
Humans
Lymph Nodes
Medical Records
Mucous Membrane
Neoplasm Metastasis
Retrospective Studies
Stomach
Stomach Neoplasms*

Figure

• 

  Fig. 1 Macroscopic type lesions of early GCLS. (A) A 10-mm subepithelial tumor-like lesion on the high body (elevated type). (B) A 14-mm hyperemic flat lesion on the antrum (flat type). (C) A 12-mm shallow ulcerative lesion on the angle (depressed type). GCLS = gastric carcinoma with lymphoid stroma.

• 

  Fig. 2 Clinical courses of patients with early GCLS treated with endoscopic submucosal dissection. GCLS = gastric carcinoma with lymphoid stroma; LRM = lateral resection margin; SM1 = penetration <500 μm of the submucosal layer; SM2 = penetration >500 μm of the submucosal layer.

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