Atypical Architecture of Gastric Adenocarcinoma: Three-Dimensional Morphology as a Basis for Diagnosis T. Takahashi 1 , N. Iwama 1 1Department of Pathology, The Research Institute for Tuberculosis and Cancer, Tohoku University pp.633-639
Published Date 1983/6/25
DOI https://doi.org/10.11477/mf.1403109462
  • Abstract
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 The histopathological diagnosis of gastric adenocarcinoma depends not only on cellular abnormalities but on the bizarre architecture of glands. The latter feature is generally used intuitively rather than on the basis of strict morphological criteria. Even so, it may be important in dealing with the so-called borderline lesions or with carcinoma with minimal dysplasia. This basic architectural pattern was established by three-dimensional reconstruction of atypical glands and their lumina from serial histologic sections in four gastrectomy specimens with adenocarcinoma of various histological types. A reconstruction in moderately differentiated adenocarcinoma (tub2) disclosed that the carcinomatous glands, having multiple anastomoses, formed a characteristic three-dimensional network, quite different from the arborescent pattern of normal gastric glands. On the other hand, the lumina were separated into many small parts, giving the cell masses a peculiar, porous character. Well differentiated tumor (tub1) had more connections between lumina, giving rise to the formation of dense luminal network, while in the poorly differentiated variety (por) the glandular structures lost their mutual connections, being broken up into fragmental nests. These abnormalities found their two-dimensional expression in: 1) net-like interconnection of glands, 2) back-to-back pattern, 3) cystic dilatation and rupture of overdistended lumina, and 4) disunion of cell nests. Thus it appears that the three-dimensional reconstruction studies are helpful in interpreting two-dimensional pictures in histologic sections, and also in establishing a morphological basis for the discrimination of dysplastic from overtly malignant lesions.

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