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ESD Treatment for Histologically Mixed-type Early Gastric Cancer (Including Recurrence and Metastasis to the Lymph Node) Junko Fujisaki 1 , Yorimasa Yamamoto 1 , Noriko Yamamoto 2 , Yo Kato 2 , Makoto Tatewaki 1 , Tomohiro Tsuchida 1 , Etsuo Hoshino 1 , Hiroshi Takahashi 1 , Masahiro Igarashi 1 1Gastrointestinal Center, Cancer Institute Hospital, Tokyo 2Pathology Division, Cancer Institute Hospital, Tokyo Keyword: 早期胃癌 , 未分化混合型 , ESD pp.1659-1669
Published Date 2007/10/25
DOI https://doi.org/10.11477/mf.1403101216
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 We studied 29 cases of histologically mixed-type out of 440 cases of early gastric cancer resected by endoscopic submucosal dissection (ESD). All the cases were diagnosed by biopsy as differentiated adenocarcinoma. In 411 cases (93.4%), biopsy diagnosis and the ESD final pathological diagnosis were the same viz. differentiated adenocarcinoma. However, in 29 cases (6.6%), the biopsy diagnosis differed from the ESD final pathological diagnosis. Biopsy diagnosis indicated adenocarcinoma but the ESD final pathological diagnosis indicated differentiated or poorly-differentiated mixed-type cancers. There were 17 cases (4%) of submucosal invasive cancer that were diagnosed by both biopsy and ESD as being the same histologically. However, there were 14 cases (48%) of SM cancers which were diagnosed histologically as mixed-type.

 From the degree of submucosal invasion, there were 8 cases (47%) of SM2 cancers of differentiated type, but, in contrast to this, there were 10 cases (71%) of SM2 cancers which were histologically mixed-type. In the SM1 cancers, lymphatic and venous permeation was found in 1/9 (11%). In SM2 cancers, 5/8 (63%) cases were differentiated type, and lymphatic and venous permeation was found in 3/4 (75%) of cases of SM1 cancers, and it was found in 6/10 (60%) of cases of SM2 mixed-type cancers. SM invasion and lymphatic permeation were of higher frequency in mixed-type cancers, and lymphatic and venous permeation was especially high in frequency in SM1 mixed-type cancers. 12 cases of SM mixed type cancers were surgically operated on after ESD. There was no lymph node metastasis in operated cases. 2/394 (0.5%) cases were found to be incompletely resected cases in the differentiated type cancers, but 3/15 (20%) were found to be incompletely resected cases in the histologically mixed-type cancers. Also, in 3 cases of incomplete resection residual lesion was detected in the histologically mixed-type cancers. In all cases it was difficult to correctly diagnose the boundary of the lesion. And all the cases had a histological appearance like moderately differentiated adenocarcinoma. We showed in this study that histologically mixed-type well-to-poorly differentiated adenocarcinoma was likely to invade the submucosa and had a high frequency of lymphatic and venous peameation, and it was difficult to make a correct diagnosis of the boundary of the lesion.


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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