Endoscopic Features of Differentiated-Type Early Gastric Carcinoma with Gastric Mucin Phenotype Ichiro Oda 1 , Takuji Gotoda 1 , Noriaki Hasuike 1 , Hisanao Hamanaka 1 , Takako Eguchi 1 1Endoscopy Division, National Cancer Center Hospital Keyword: 胃癌 , 胃型 , 腸型 , 内視鏡診断 pp.684-692
Published Date 2003/4/25
DOI https://doi.org/10.11477/mf.1403100861
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 Endoscopic mucosal resection (EMR) for differentiated-type intramucosal carcinoma of the stomach has been widely accepted. Traditionally, most differentiated-type gastric carcinomas (DGA) have been considered to be intestinal type by Lauren's classification and their histogenesis is thought to be associated with intestinal metaplasia. Recently, among DGA, the gastric phenotype expression has been demonstrated by mucin histochemical and immunohistochemical analysis. It has been reported that DGA with gastric phenotype often has an undifferentiated component, histologically. However, endoscopic features of DGA with gastric phenotype have been reported in a few cases. In this study, we reviewed the endoscopic features of 168 patients with early DGA who underwent gastrectomy at the National Cancer Center Hospital beween 1994 and 1996. Cases were divided into four mucin phenotypes according to the expression of mucin histochemical and immunohistochemical staining ; gastric mucin phenotype (G type,45 lesions), intestinal mucin phenotype (I type, 33 lesions), mucin phenotype combined with both gastric and intestinal mucin (G-I type, 90 lesions), and non-mucin type (LOM, 11 lesions).

 Macroscopically, a significant number of the G-type lesions showed an unclear margin (25/45 ; 55.6 %) and normal color (24/45, 53.3%) in contrast to the G-I type (19/90 ; 21.1%, 19/90 ; 21.1%) and I type (3/33 ; 9.1 %, 6/33 ; 18.2%). Depressed type (IIc) was more frequent among all groups, and elevated and depressed type (IIa+IIc) were found more frequently in the G type (14/45 ; 31.1 %) than in the G-I type (12/90 ; 13.3%) and I type (3/33 ; 9.1%). The accuracy rate of endoscopic diagnosis concerning the depth of invasion for intramucosal cancer is lower in the G type (73.9%) and G-I type (74.1%) than in the I type (95.0%).

 These results suggest that, when deciding the indication for EMR, we should keep in mind the characteristics of G type DGA such as its high rate of having an undifferentiated component, unclear margin and low accuracy rate in the endoscopic diagnosis of depth of invasion.

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