Clin Endosc.  2019 Jan;52(1):15-20. 10.5946/ce.2018.193.

Risk Factors for Lymph Node Metastasis in Undifferentiated-Type Gastric Carcinoma

• Kook MC

• KMID: 2438139
• DOI: http://doi.org/10.5946/ce.2018.193

Abstract

Undifferentiated-type carcinoma has a high incidence of lymph node metastasis. The independent risk factors for lymph node metastasis in undifferentiated-type carcinoma are invasion depth, tumor size, lymphovascular invasion, and presence of ulcer. In the cases that meet the curative resection criteria, no lymph node metastasis was observed in the Japanese studies, but some metastases were observed in Korean studies. After performing curative endoscopic submucosal dissection, the survival rate is similar to that of gastrectomy. The discrepancy between endoscopy and pathology is high in undifferentiated-type carcinoma. The tumor size in endoscopy is a significant risk factor for non-curative resection, and when the tumor size is small, the non-curative resection rate is significantly reduced. Lymphovascular invasion can be assessed in pathologic examination and D2-40 stain is helpful. The presence of ulcer should be determined by pathology, but ulcer's omission in pathology report makes the analysis difficult. Undifferentiatedtype carcinomas with differentiated-type components show higher lymph node metastasis rate than that of pure undifferentiatedtype carcinomas. The lymph node metastasis rate of signet ring cell type is lower than that of other undifferentiated-type carcinomas and is similar to differentiated-type carcinomas. The application of these additional histologic findings may improve the indication of endoscopic submucosal dissection.

Keyword

Undifferentiated-type carcinoma; Endoscopic mucosal resection; Lymph node metastasis

MeSH Terms

Asian Continental Ancestry Group
Endoscopy
Gastrectomy
Humans
Incidence
Lymph Nodes*
Neoplasm Metastasis*
Pathology
Risk Factors*
Survival Rate
Ulcer

Figure

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  Fig. 1. Findings of D2-40 immunohistochemistry (×100). (A) Distribution of lymphatics: The majority of lymphatic vessels are distributed over the deep lamina propria (deep LP), the muscularis mucosae (MM), and the upper layer of the submucosa (upper SM). A small number of lymphatic vessels can be present in the more superficial layer of the lamina propria (arrow). (B) Lymphatic invasion: The lymphatic vessels stained with D2-40 antibody are shown as brown-colored spaces and tumor cells (arrows) are present within the lumen.

• 

  Fig. 2. Findings of ulcer. (A) Healed ulcer in a pathologic slide: Disruption and fibrous replacement (*) of the muscularis mucosae compared to the adjacent intact area (**) (hematoxylin-eosin stain, ×40). (B) Endoscopic finding of (A): No definite ulcer change was diagnosed in endoscopy.

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