Distinct expression profile of key molecules in crawling-type early gastric carcinoma

Abstract

CRA demonstrated unique clinicopathological characteristics and showed a distinct expression profile of key molecules, which was close to that of a null phenotype. These results support the classification of CRA as a distinct subgroup of gastric adenocarcinoma.

Analysis of clinicopathological and molecular features of crawling-type gastric adenocarcinoma

“…Several studies demonstrated that CRA was associated with specific histological patterns and had characteristic clinicopathological findings [3][4][5][6][7]. Despite its characteristic histological features, CRA is not included in the WHO classification as a distinct histological subtype.…”

“…CRA may occur with low frequency in Western countries that have a low prevalence of H. pylori infection, which can produce intestinal metaplasia. Some recent studies indeed suggested that CRA could be considered as a specific histological entity of GC [3,5], but to date CRA has not yet been histologically established as a recognizable subtype. CRA having lowgrade cellular atypia may in fact closely mimic intestinal metaplasia.…”

“…We retrospectively examined 177 lesions, comprising 51 and 126 CRAs and CDAs, respectively, which were obtained from patients who underwent surgical or endoscopic resection for GC at Iwate Medical University Hospital (Iwate, Japan) between 2010 and 2018. We defined CRA as an adenocarcinoma having branching or anastomosing glands resembling the shapes of the letters W, H, Y or X composed of neoplastic epithelium with low-grade nuclear atypia, as previously proposed [5,7]. Meanwhile, CDA was defined as an adenocarcinoma that is characterized by tumors having tubular or papillary formations (i.e., CDA corresponds to differentiatedtype cancers).…”

“…The most common histopathological subtype is tubular adenocarcinoma, which can be subclassified into two grades of well-or moderately-differentiated adenocarcinoma [2]. Crawling-type adenocarcinoma (CRA) is an important subtype among moderately-differentiated adenocarcinomas and has attracted increased attention as a specific histological GC subtype due to its characteristic clinicopathological and molecular findings [3][4][5][6].…”

“…CRA is also referred to as a very well-differentiated gastric carcinoma of the intestinal type [7]. Although cancer glands in CRA show a complex architecture described as a "shaking-hands pattern" or "WHYX pattern" [5,7], due to subtle cytological atypia such tumor glands can appear to be an "intestinal metaplasia" that is a benign lesion. Therefore, distinguishing this type of GC from non-neoplastic lesions, such as intestinal metaplasia, can be challenging.…”