Clinical Endoscopy

Review

Borrmann Type 4 Advanced Gastric Cancer: Focus on the Development of Scirrhous Gastric Cancer: Kyoungwon Jung, Moo In Park, Sung Eun Kim, Seun Ja Park; Clin Endosc 2016;49(4):336-345. Published online July 25, 2016; DOI: https://doi.org/10.5946/ce.2016.057

Early diagnosis of Borrmann type 4 advanced gastric cancer (AGC) is very important for improving the prognosis of AGC patients. Because there is no definite mass in most cases of Borrmann type 4 AGC, its accurate diagnosis via endoscopy requires an understanding of its pathogenesis and developmental process. Moreover, many people confuse linitis plastica (LP) type gastric cancer (GC), scirrhous GC, and Borrmann type 4 AGC. To distinguish each of these cancers, knowledge of their endoscopic and pathological differences is necessary, especially for LP type GCs in the developmental stage. In conclusion, diagnosis of pre-stage or latent LP type GC before progression to typical LP type GC requires the detection of IIc-like lesions in the fundic gland area. It is also crucial to identify any abnormalities such as sclerosis of the gastric wall and hypertrophy of the mucosal folds during endoscopy.

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Original Article

Early Gastric Cancer-Like Advanced Gastric Cancer versus Advanced Gastric Cancer-Like Early Gastric Cancer: Hyun Sik Park, Sun-Young Lee, Sung Noh Hong, Jeong Hwan Kim, In-Kyung Sung, Hyung Seok Park, Chan Sup Shim, Choon Jo Jin; Clin Endosc 2013;46(2):155-160. Published online March 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.2.155

Abstract PDF PubReader ePub

Background/Aims

Improvements in the endoscopic evaluation and management of gastric cancer have made it possible to determine the depth of invasion during endoscopic examination. The aim of this study was to elucidate the differences between early gastric cancer (EGC) that resembles advanced gastric cancer (AGC) and AGC that resembles EGC.

Methods

We retrieved cases of EGC-like AGC and AGC-like EGC from consecutive gastric cancers that had been completely resected. The endoscopic diagnoses and clinicopathological findings were analyzed.

Results

AGC-like EGCs were located mainly in the distal part of the stomach, whereas EGC-like AGCs were located mainly in the proximal part of the stomach (p<0.001). Sixty percent of AGC-like EGCs were moderately differentiated adenocarcinomas, while 64% of EGC-like AGCs were poorly differentiated adenocarcinomas (p=0.015). According to Lauren's classification, 68% of AGC-like EGCs were intestinal type, whereas 71% of EGC-like AGCs were diffuse type (p=0.020).

Conclusions

AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Lauren's diffuse type, and invade deeper than their endoscopic appearance might suggest.

Citations

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miR-199a and miR-199b facilitate diffuse gastric cancer progression by targeting Frizzled-6
Soon Auck Hong, Sieun Lee, Jihye Park, Mineui Hong, Jung-Sook Yoon, Heejin Lee, Ji Hyun Lee, Seoree Kim, Hye Sung Won, Keunsoo Kang, Yoon Ho Ko, Young-Ho Ahn
Scientific Reports.2023;[Epub] CrossRef
Microbiota and the Immune System—Actors in the Gastric Cancer Story
Marek Majewski, Paulina Mertowska, Sebastian Mertowski, Konrad Smolak, Ewelina Grywalska, Kamil Torres
Cancers.2022; 14(15): 3832. CrossRef
Analysis of Endoscopy Findings to Identify Early Gastric Cancers with Tumor Budding: A Retrospective Study
Lanqing Cao, Zhaoyong Wang, Liwei Duan, Lijuan Wei
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Chiranjit Ghosh, Varoon Singh, Jonathan Grandy, Janusz Pawliszyn
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Long term oncological outcome of patients with grossly early gastric cancer-mimicking advanced gastric cancer
Sung Eun Oh, Ji Yeong An, Min-Gew Choi, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Jun Ho Lee
European Journal of Surgical Oncology.2020; 46(7): 1262. CrossRef
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Sung Eun Oh, Ji Yeong An, Min-Gew Choi, Tae Sung Sohn, Jae Moon Bae, Jun Ho Lee
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Jin Sung Koh, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Hoon Jai Chun, Sang Woo Lee, You-Jin Jang, Young-Jae Mok, Masaru Katoh
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A Case of Advanced Gastric Cancer and the First Symptom was a Skin Lesion: Sang Hyun Park, M.D., Sang Dae Lee, M.D., Tae Ung Lee, M.D., Hong Sun Son, M.D., Sang Jin Cho, M.D., Dong Il Byun, M.D., In Sik Park, M.D.* and Su Nam Lee, M.D.^†; Korean J Gastrointest Endosc 2009;38(2):90-93. Published online February 27, 2009

Abstract PDF: Cutaneous metastasis of internal malignancies is rare and the incidence of metastatic skin lesions as the first symptom of disease is only 0.8% for patients with all types of malignancies. Furthermore, cutaneous metastasis from advanced gastric cancer is exceedingly rare. A 43-year-old man presented with a single, symptomatic, erythematous nodule on the chest wall. A biopsy taken from the nodule showed an adenocarcinoma of the poorly differentiated type. An endoscopic examination and biopsy was done and these showed the same histologic findings. We reported here on this unusual case of advanced gastric cancer and the patient's first symptom was a skin lesion. (Korean J Gastrointest Endosc 2009;38:90-93)

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A Case of Multiple Colon Ulcers due to Complications of S-1 (TS-1): Hye Jeong Park, M.D., Dong Soo Han, M.D., Hyun Chul Kim, M.D., Hyun Seok Cho, M.D., Chang Soo Eun, M.D., Yong Cheol Jeon, M.D., Joo Hyun Sohn, M.D. and Jung-Hye Choi, M.D.; Korean J Gastrointest Endosc 2008;37(4):308-311. Published online October 30, 2008

Abstract PDF: S-1 (TS-1) is an oral anticancer drug that contains a prodrug of 5-fluorouracil. This drug exhibits high efficacy with it is used as single therapy or in combination therapy for gastrointestinal cancer, and especially advanced gastric cancer. There have not been any reports about grade 3 or 4 adverse events when using S-1. We report here on a case of multiple colon ulcers after S-1 chemotherapy in a patient with advanced gastric cancer. (Korean J Gastrointest Endosc 2008;37:308-311)

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Two Cases of Huge Polypoid Early Gastric Cancer: Seong Eun Yang, M.D., Chang Whan Kim, M.D., Sok Won Han, M.D., Young Seok Cho, M.D., Dong Soo Lee, M.D., Jin Il Kim, M.D., Soo Heon Park, M.D., Hiun Suk Chae, M.D., Myung Gyu Choi, M.D., Jae Kwang Kim, M.D., Kyu Young Choi, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2006;32(1):37-41. Published online January 30, 2006

Abstract PDF: Gastric cancer is the most frequent cancer seen in Korea. The development of diagnostic procedures such as endoscopy has contributed to the early diagnosis and subsequent treatment of gastric cancer. Early gastric cancer has been defined as a carcinoma that is limited to the gastric mucosa or submucosa, regardless of the presence of lymph node metastasis. The prognosis of gastric cancer mainly depends on the depth of invasion and the lymph node metastasis. However it is difficult to distinguish large type I early gastric cancer from Borrmann type 1 advanced gastric cancer when the distinction is based on the macroscopic appearance. We experienced two cases of huge polypoid early gastric cancer. One case was treated by operation, and the other case was treated by endoscopic mucosal resection. We report here on two cases of huge polypoid early gastric cancer mimicking advanced gastric cancer. (Korean J Gastrointest Endosc 2006;32:37⁣41)

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증례 : 식도 위장관 ; 조기위암으로 오인된 침윤성 진행성위암 1예 ( Case Reports : Esophagus , Stomach & Intestine ; Infiltrative Advanced Gastric Cancer Simulating Early Gastric Cancer - Case report - ): Korean J Gastrointest Endosc 1997;17(2):187-193. Published online November 30, 1996

Abstract PDF: Advanced gastric cancer simulating early gastric cancer is increasing tendcncy due to development of diagnostic technology. A 64-year-old woman was admitted for epigastric discomfort. Endoscopy showed a small white mucus coated erosion and peripheral mucosal nodurarity on greater curvature side of antrum. Biopsy was resulted in adenocarcinoma. An upper GI series and abdominal sonography were normal. At surgery, advanced gastric carcinoma, Borrmann localized type IV in background of early gastric carcinoma, prepyloric antrum along the greater curvature with infiltration to the muscle layer and multiple lymphatic tumor emboli in serosa and perigastric adipose tissue and neural invasion and metastasis to 12 out of 28 perigastric lymph nodes with extranodal extension. 3 months later, distant metastasis such as cervical lymph node, pleural effusion, pericardial effusion, peritoneal seeding and ascites were noticed. (Korean J Gastrointest Endosc 17: 187-191, 1997)

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위암과 동반된 Leiomyomatosis Peritonealis Disseminata 1예 ( A Case of Leimyomatosis Peritonealis Disseminata Combined with Advanced Gastric Cancer ): Korean J Gastrointest Endosc 1992;12(1):53-56. Published online November 30, 1991

Abstract PDF: Leiomyomatosis peritonealis disseminata is a rare benign condition characterised by the occurrence of multiple leimyomas scatterred throughout the peritoneal cavity, giving the clinical impression of a wide spread malignant tumor. The histopathology of leiomyomatosis peritonealis disseminata is that of a benign leiomyoma, probably originating from the multipotent subcoelomic mesenchymal cells. Three cases with malignant transformation were described among previous reported fifty cases. Many of the early reports described the disorder in premenopausal women, and now the histogenesis is considered to be a metaplastic change by abnormal tissue response to the relatively or absolutely elevated female sex hormone. We report a case of leiomyomatosis peritonealis disseminata, which was diagnosed by multiple scattered submucosal and subseroal leimyomas of stomach, small bowel and colon, combined with advanced gastric cancer in a 58 years old man, Multiple submucosal tumors of the stomach combined with advanced gastric cancer were demonstrated by fibergastroscopy, upper gastrointestinal barium study and abdominal ultrasonography. During radical subtotal gastrectomy multiple submucosal and subserosal tumors of stomach, and subserosal tumors of small bowel and colon were observed and these tumors were confirmed as leiomyoma without malignant potential.

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