Pathological Diagnosis of Depth of Invasion of Early Gastric Adenocarcinomas with Special Reference to Their Gross Features Shinichi Ban 1 , Hideaki Sato 1 , Masaki Yamada 2 , Haruhiko Okada 2 , Yasunori Ishido 2 , Tetsuya Saito 2 , Naoki Negami 2 , Suguru Watabe 2 , Masahiko Sato 2 1Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan 2Department of Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan Keyword: 早期胃癌 , 病理 , 肉眼像 , 深達度 , 肉眼・組織対応 pp.8-20
Published Date 2014/1/25
DOI https://doi.org/10.11477/mf.1403114043
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 We analyzed 119 surgically resected early gastric cancers, which included 60 lesions limited to the mucosa(M cancers)and 59 lesions infiltrating to the submucosa(SM cancers), to highlight gross and histologic features with regard to their submucosal invasion. It should be noted that the lesions with maximum diameter of 2-3cm, which are resectable endoscopically, frequently showed submucosal invasion. Dividing SM cancers into 12 SM1 cancers and 47 SM2 cancers based on their depth of invasion, gross alterations at the histologically confirmed submucosal invasion sites were identified in 31 out of 47(66%)of SM2 cancers. In all of the SM1 cancers and in about half of the SM2 cancers, intramucosal carcinoma was wholly preserved at the submucosally invasive areas, and this is one of the factors which make the diagnosis of depth of invasion difficult. One noted finding helpful in the diagnosis of submucosal invasion was the elevation of mucosal elements as a result of the invasive cancer mass. In the present series, such lesions showed an invasion distance of>2,000μm and the width of the invasion area was>0.5cm. The diagnosis of submucosal invasion could be complicated by the association of ulcer and/or ulcer scar(UL)in depressed cancers. Another challenging situation is submucosal invasion through lymphatic vessels which show few gross changes suggestive of submucosal invasion. Recognizing the factors that would make the gross diagnosis of submucosal invasion difficult, thorough examination of the resected materials is mandatory.

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