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Clinical Features and Issues of Early Gastric Cancer Which Consist with the Elements of Well and Poorly Differentiated Adenocarcinoma―Mainly by Conventional Endoscopy Akio Matsuda 1 , Yoshito Nishimata 1 , Toru Niihara 1 , Tatsuyuki Niou 1 , Shunji Shimaoka 1 , Hiromitsu Torimaru 1 , Koutaro Tashiro 1 , Hiroto Nishimata 1 , Sadao Tanaka 2 , Koichi Kawaida 3 , Toyokuni Suenaga 3 , Hidehisa Ohi 4 1Department of Gastroenterology, Nanpu Hospital, Kagoshima, Japan 2Department of Pathology, Nanpu Hospital, Kagoshima, Japan 3Department of Surgery, Nanpu Hospital, Kagoshima, Japan 4Department of Gastroenterology, Imamura Hospital, Kagoshima, Japan Keyword: 未分化型混在早期胃癌 , 内視鏡診断 , 内視鏡的粘膜下層剥離術 pp.1615-1624
Published Date 2007/10/25
DOI https://doi.org/10.11477/mf.1403101211
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 Although endoscopic submucosal dissection (ESD) has been developed and widely accepted for early gastric cancer that is expected not to metastasize to the lymph nodes, consensus has not been reached on the treatment for well differentiated early gastric cancer complicated with the element of poorly differentiated carcinomas. In Nanpuh Hospital, 171 patients with intramucosal gastric carcinoma underwent surgery between April 2001 and April 2007. Eighty-eight and 61 lesions were diagnosed as well differentiated and poorly differentiated adenocarcinoma, respectively. The other 22 lesions consisted with the elements of well and poorly differentiated adenocarcinoma and were evaluated in this study. The tumors ranged in size from 1.3 cm to 9 cm, with an average of 3.8 cm. On macroscopic findings, all cases had mainly depressed lesions and 11 cases had ulcers or ulcer scars. Of 11 cases, three lesions had not been detected on preoperative examinations. The lesions were reddish in 8 cases, discolored in 8 cases and normal in color in 6 cases. The properties of the depressed surfaces of the lesions were similar to the gastric area in 10 cases, 11 cases had a large and small granulated pattern, and one case has a flat and smooth surface resulting from the indistinct gastric area. The macroscopic appearance was intermediate between poorly and well differentiated carcinoma. On endoscopic examination, 8 lesions showed distinct margins around the entire circumference, 11 had distinct margins on more than half but less than the whole circumference, and 3 had distinct margins on less than half the circumference, and therefore had mostly indistinct margins. The lesions which had some areas of poorly differentiated adenocarcinomas showed a large and small granulated pattern in the depressed surfaces, which allowed us to determine the location of the poorly differentiated carcinoma. However, in the tumor with scattered elements of the poorly differentiated carcinoma, it was not possible to determine the location of the poorly differentiated carcinoma based on the characteristics of the depressed surfaces. The cases which consist with the elements of well and poorly differentiated adenocarcinoma on histopathological investigation of resected specimens require careful treatment due to the risk of lymph node metastasis.


Copyright © 2007, Igaku-Shoin Ltd. All rights reserved.

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

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