A case of small undifferentiated intramucosal gastric cancer with lymph node metastasis

Nasu, Junichirou; Hori, Shinichiro; Asagi, Akinori; Nishina, Tomohiro; Ikeda, Yoshio; Tanimizu, Masahito; Iguchi, Haruo; Aogi, Kenjiro; Kurita, Akira; Nishimura, Rieko

doi:10.1007/s10120-010-0562-3

Cited by 11 publications

(8 citation statements)

References 12 publications

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“…Previous case reports with LN metastasis from undifferentiated-type mucosal gastric cancer satisfying the expanded criteria showed similar characteristics of middle age women with mixed histology. 38 , 39 From these observations we could suggest that middle age woman with mixed histology needs more intense surveilance of recurrence although CR has been achieved.…”

Section: Discussionmentioning

confidence: 93%

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

Kwak

Lee

et al. 2018

Gut and Liver

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Background/AimsOutcomes of endoscopic submucosal dissection (ESD) for undifferentiated-type early gastric cancer (EGC) need to be further evaluated. We aimed to simulate the outcomes of ESD for undifferentiated-type EGC from a surgical database.MethodsAmong 802 patients who underwent gastrectomy with endoscopic biopsy for poorly differentiated adenocarcinoma (PD-type) or signet ring cell carcinoma (SRC-type), ESD candidates meeting the expanded indication (n=280) were selected by reviewing the endoscopic images. According to the surgical pathologic results, the outcomes of the ESD simulation were evaluated.ResultsAmong the candidates, 104 (37.1%) were PD-type and 176 (62.9%) were SRC-type. The curative resection (CR) rate was 42.1%. Among the patients with CR, three patients (2.5%) showed lymph node metastasis (LNM). Three EGCs with CR and LNM were mucosal cancers ≥1.0 cm in size. The CR rate was higher in the SRC-type than in the PD-type (48.3% vs 31.7%, respectively, p=0.007). In the SRC-type, the CR rate was increased, with a smaller size criterion for the ESD indication, but was similar between the 1.0 cm and 0.6 cm criteria (63.3% and 63.6%, respectively), whereas the CR rate was below 50% in all of the different tumor size criteria (2.0 to 0.6 cm) in the PD-type.ConclusionsIn undifferentiated-type EGC, ESD should be considered in selected patients with tumor sizes <1 cm and SRC histology.

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Section: Discussionmentioning

confidence: 93%

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

Kwak

Lee

et al. 2018

Gut and Liver

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“…On the other hand, there are only case reports that describe nodal involvement in small undifferentiated Eastern EGC [8,9].…”

Section: Introductionmentioning

confidence: 99%

The role of E-cadherin expression in the treatment of western undifferentiated early gastric cancer: Can a biological factor predict lymph node metastasis?

et al. 2020

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The use of endoscopic techniques to cure small sized, well differentiated early gastric cancer has been adopted worldwide. In the Eastern world, endoscopic resection is being increasingly utilized to treat small undifferentiated early gastric cancer according to the extended criteria proposed by the Japanese Gastric Cancer Associations. However, studies in the Western world reported in these tumors a rate of nodal metastasis ranging between 5% and 20%, that is higher of those observed in Eastern counterparts. A tool to predict the risk of nodal dissemination would be of great use to guide treatment toward endoscopic resection. In our study, we propose E-cadherin expression as a biological factor to predict lymph node involvement. We retrospectively reviewed the E-cadherin (E-cad) expression profile of all histological specimens of undifferentiated early gastric cancer from two Oncologic Departments and compared it with several tumor characteristics. A total of 39 patients with early gastric cancer met the inclusion criteria, of which 16 (41%) pT1a, and 23 (58.9%) pT1b SM1. Thirty-two patients (82%) underwent subtotal gastrectomy, whereas total gastrectomy was performed in only seven cases (17.9%). Patients were divided into two groups: low E-cad expression (E-cad 0/1+, 10 patients) and high E-cad expression (E-cad 2+/3+, 29 patients) according to the immunohistochemical assay (ICH). On univariate analysis, we found an association between low E-cad expression and low grading tumor (p = 0.019), pure undifferentiated histotype (PU-type) (p = 0.014), and lymph node involvement (N+) (p < 0.001). The association between low E-cad expression and lymph node metastasis was confirmed by multivariate analysis (OR = 14.5, 95% CI 3.46-60.76, p < 0.001). The loss of expression of E-cad may be a simple biological factor to predict lymph nodes metastasis in patients with undifferentiated early gastric cancer. Additional larger prospective studies are necessary to confirm these findings.

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“…Then two brief reports were submitted to this journal, each describing a case of lymph node metastasis from a UD-type tumor that satisfi ed the above criteria. The case reported by Nasu and colleagues in this issue [6] was a 13-mm IIc lesion with signet-ring cells spreading only in the superfi cial third of the mucosal layer. No ulcer, breakdown of muscularis mucosa, or submucosal fi brosis was seen.…”

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confidence: 91%

Endoscopic resection of undifferentiated-type gastric carcinoma: an extreme step to be restrained?

Sano

2010

Gastric Cancer

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minute submucosal invasive cancer less than 3 cm, all on condition that the tumor is histologically of the differentiated type.Criterion (b) was untouched for a long time because most studies failed to specify the category of undifferentiated type (UD-type) tumors free from nodal metastasis. UD-type adenocarcinomas mostly had an ulcer component and could metastasize regardless of size or depth. This does not mean that UD-type T1 tumors are oncologically more aggressive than D-type T1 tumors. The patients' survival is similar or even better in the UD-type as long as they are treated by gastrectomy with lymphadenectomy [4]. The potential of lymphatic invasion, however, seems higher in UD-type tumors, which makes ESD diffi cult.A suggestion was made in 2000 that UD-type intramucosal cancer less than 2 cm in size without an ulcer component or lymphatic-vascular capillary involvement might be suitable for ESD [2]. However, such tumors were so rare that it was only in 2009 that the authors completed a collection of 310 such cases (of 3,834 T1 tumors of UD-type) treated by surgery, found no lymph node metastasis, and thereby concluded the risk is nil, with a very narrow 95% confi dence interval, 0-0.96% [5].It seemed that the fi nal hurdle had been successfully crossed. Then two brief reports were submitted to this journal, each describing a case of lymph node metastasis from a UD-type tumor that satisfi ed the above criteria. The case reported by Nasu and colleagues in this issue [6] was a 13-mm IIc lesion with signet-ring cells spreading only in the superfi cial third of the mucosal layer. No ulcer, breakdown of muscularis mucosa, or submucosal fi brosis was seen. Five perigastric lymph nodes in the tumor drainage area contained signet-ring cell carcinoma. The second case, reported by Hirasawa and colleagues [7], in this issue as well, was also a 13-mm IIc lesion of poorly differentiated adenocarcinoma and signet-ring cell carcinoma. A large lymph node along Endoscopic mucosal resection (EMR) of gastric tumor was commenced in Japan in the 1970s to remove small superfi cial adenocarcinomas. Lymph node metastasis was the only limiting factor for EMR to be a curative treatment, and a number of studies were conducted using the surgical databases to specify gastric lesions that had never metastasized to the lymph nodes. All studies consistently showed that at least small differentiated (D-type) adenocarcinomas confi ned to the mucosal layer without ulceration were free from nodal metastasis.Because some safety margin was indispensable for a new procedure to be introduced in cancer therapy, the original indications of EMR were strictly limited to tiny tumors as described below. In the late 1990s an innovative new technique emerged using specially designed needle knives (endoscopic submucosal dissection, ESD) [1], which has dramatically changed the procedure of endoscopic resection. ESD enabled resection of large tumors or those having an ulcer component (more precisely, ESD was invented because of the necessity of resectin...

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A case of small undifferentiated intramucosal gastric cancer with lymph node metastasis

Cited by 11 publications

References 12 publications

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

Outcomes of Endoscopic Submucosal Dissection for Early Gastric Cancer with Undifferentiated-Type Histology: A Clinical Simulation Using a Non-Selected Surgical Cohort

The role of E-cadherin expression in the treatment of western undifferentiated early gastric cancer: Can a biological factor predict lymph node metastasis?

Endoscopic resection of undifferentiated-type gastric carcinoma: an extreme step to be restrained?

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