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Expanded Indication for Endoscopic Resection From the Pathological Viewpoint―The Possibility of sm Invasion by Undifferentiated-type Early Gastric Cancer Kohei Takizawa 1,2 , Tadakazu Shimoda 1 1Pathology of Clinical Laboratory Division, National Cancer Center Hospital Keyword: 早期胃癌 , 未分化型腺癌 , EMR , ESD , 適応拡大 pp.9-17
Published Date 2006/1/25
DOI https://doi.org/10.11477/mf.1403100015
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 Expanded indication for endoscopic resection in treatment of early gastric carcinoma of undifferentiated-type was considered, using 534 cases of gastric carcinomas of undifferentiated-type surgically resected from 1994 to 2001 in NCCH.

 We examined the relationships between clinicopathological features and ① the rate of lymph node metastasis, ② the possibility of sm invasion, ③ cases of lymph node metastasis from intramucosal cancer. By univariate analysis, there were statistically significant differences between lymph node metastasis and depth (sm), the presence of lymphatic involvement and venous involvement, the size of cancer (over 30 mm), histology (except for signet ring cell carcinoma), the absence of Ki-67 localization, and the absence of double layer (MUC5AC/MUC6). There were statistically significant differences between sm invasion and histology (except for signet ring cell carcinoma), positive of MUC2, negative of MUC6, the absence of Ki-67 localization, and the absence of double layer (MUC5AC/MUC6). There was statistically significant difference between lymph node metastasis and the presence of ulceration in intramucosal lesions. 14 of 15 cases that had lymph node metastasis in intramucosal lesions had ulceration. One case without ulceration was 80 mm in its largest diameter, invasion depth of the whole mucosal layer, the absence of Ki-67 localization, and the absence of double layer (MUC5AC/MUC6). Therefore, conditions where no lymph node metastasis is expected and thus where endoscopic resection is possibly effective are as follows. In case of mucosal carcinoma, ( 1 )the tumor size 10 mm or less in largest diameter, ( 2 )the presence of Ki-67 localization without ulceration, ( 3 )the presence of double layer (MUC5AC/MUC6) without ulceration, and ( 4 )only signet ring cell carcinoma without ulceration.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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