Histopathological Study on Early Gastric Carcinoma of Depressed Type in the Fundic Gland Area: Comparison between differentiated type and undifferentiated type Akinori Iwashita 1 1Department of Pathology, Matsuyama Red Cross Hospital pp.1047-1059
Published Date 1987/9/25
DOI https://doi.org/10.11477/mf.1403113005
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 Histopathological study on depressed type early gastric carcinoma in the anatomical fundic gland area with or without intestinal metaplasia was done in 62 lesions of 58 resected specimens obtained from 58 patients. The results were as follows.

 1) The 62 lesions were histopathologically classified as differentiated (29) and undifferentiated types (33), according to Nakamura. The average age was 59 years for the differentiated type and 54 for the undifferentiated type, and the male to female ratio, twenty-two to five and thirteen to eighteen, respectively. While the undifferentiated type was found in 78% of the females and 38% of the males, the differentiated type was found in 22% and 62%, respectively. Among the patients 49 years old or younger differentiated type was recognized only in the males.

 2) The largest diameter was, on average, 24 mm for the differentiated type and 32 mm for the undifferentiated type. Submucosal invasion was found in 41% of the differentiated type and 55% of the undifferentiated type, and in the latter, it was found even when the cancer being smaller than 10 mm in diameter.

 3) Peptic ulcer accompanied the carcinoma in 72% of the differentiated type and in 91% of the undifferentiated type. Almost all the ulcers were superficial, Ul-Ⅱ or healed. The carcinoma with clear borders was seen in 79% of the differentiated type and 91% of the undifferentiated type. Seventy-two percent of the differentiated type showed expansive growth pattern and 88% of the undifferentiated type revealed infiltrative growth pattern.

 4) While intestinal metaplasia in the fundic gland mucosa surrounding the carcinoma was moderate to severe in the differentiated type, it was and nil to slight in the undifferentiated type, The severity of mucosal atrophy was comparable to that of intestinal metaplasia. Interestingly, there was a case of differentiated type with no intestinal metaplasia around the carcinomatous focus.

 5) Submucosal fibrosis associated with carcinomatous invasion was more severe in the undifferentiated type. The frequency and the extent of lymphatic permeation were about the same in both types.

 6) The mucosal fibrosis in the carcinomatous focus was found in only 4 lesions, all of which revealed marked submucosal fibrosis as well.

 Based on these results it is said that the clinicopathological characteristics are distinctive between differentiated and undifferentiated types of early gastric carcinoma. A brief discussion was made on the initial lesion of the “linitis plastica”-type carcinoma.

Copyright © 1987, Igaku-Shoin Ltd. All rights reserved.


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