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Difference between revisions of "Stomach carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = | | Image = Signet ring cell carcinoma - very high mag.jpg | ||
| Width = | | Width = | ||
| Caption = | | Caption = Stomach signet ring cell carcinoma. [[H&E stain]]. | ||
| Synonyms = | | Synonyms = | ||
| Micro = | | Micro = | ||
| Subtypes = Lauren classification: intestinal type, diffuse type; WHO classification: papillary carcinoma, tubular carcinoma, mucinous carcinoma, signet-ring carcinoma, undifferentiated carcinoma, [[adenosquamous carcinoma]] | | Subtypes = Lauren classification: intestinal type, diffuse type; WHO classification: papillary carcinoma, tubular carcinoma, mucinous carcinoma, signet-ring carcinoma, undifferentiated carcinoma, [[adenosquamous carcinoma]] | ||
| LMDDx = | | LMDDx = [[gastric xanthoma]], [[neuroendocrine tumour]], metastatic carcinoma (e.g.[[pancreatic ductal adenocarcinoma]], [[gastric dysplasia]] | ||
| Stains = CK7 +ve, CK20 -ve/+ve | | Stains = CK7 +ve, CK20 -ve/+ve | ||
| IHC = | | IHC = | ||
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| Site = [[stomach]] | | Site = [[stomach]] | ||
| Assdx = | | Assdx = | ||
| Syndromes = [[familial adenomatous polyposis]], [[Lynch syndrome]] | | Syndromes = [[hereditary diffuse gastric cancer]], [[familial adenomatous polyposis]], [[Lynch syndrome]], [[Peutz-Jeghers syndrome]], [[Li-Fraumeni syndrome]], [[Gastric adenocarcinoma and proximal polyposis of the stomach]] (GAPPS) | ||
| Clinicalhx = | | Clinicalhx = | ||
| Signs = | | Signs = | ||
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| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = +/-[[linitis plastica]] (diffuse carcinomas), +/-ulcer with heaped (raised) edges (intestinal carcinomas) | ||
| Prognosis = usually very poor | | Prognosis = usually very poor | ||
| Other = | | Other = | ||
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*Associated with helicobacter infections, i.e. [[Helicobacter gastritis]]. | *Associated with helicobacter infections, i.e. [[Helicobacter gastritis]]. | ||
*[[Alcohol]] - heavy use.<ref name=pmid21993435>{{Cite journal | last1 = Duell | first1 = EJ. | last2 = Travier | first2 = N. | last3 = Lujan-Barroso | first3 = L. | last4 = Clavel-Chapelon | first4 = F. | last5 = Boutron-Ruault | first5 = MC. | last6 = Morois | first6 = S. | last7 = Palli | first7 = D. | last8 = Krogh | first8 = V. | last9 = Panico | first9 = S. | title = Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. | journal = Am J Clin Nutr | volume = 94 | issue = 5 | pages = 1266-75 | month = Nov | year = 2011 | doi = 10.3945/ajcn.111.012351 | PMID = 21993435 }}</ref> | *[[Alcohol]] - heavy use.<ref name=pmid21993435>{{Cite journal | last1 = Duell | first1 = EJ. | last2 = Travier | first2 = N. | last3 = Lujan-Barroso | first3 = L. | last4 = Clavel-Chapelon | first4 = F. | last5 = Boutron-Ruault | first5 = MC. | last6 = Morois | first6 = S. | last7 = Palli | first7 = D. | last8 = Krogh | first8 = V. | last9 = Panico | first9 = S. | title = Alcohol consumption and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. | journal = Am J Clin Nutr | volume = 94 | issue = 5 | pages = 1266-75 | month = Nov | year = 2011 | doi = 10.3945/ajcn.111.012351 | PMID = 21993435 }}</ref> | ||
*Genetic syndromes | *Genetic syndromes: | ||
**[[Hereditary diffuse gastric cancer]]. | |||
**[[Familial adenomatous polyposis]]. | |||
**[[Peutz-Jeghers syndrome]]. | |||
**[[Lynch syndrome]]. | |||
**[[Gastric adenocarcinoma and proximal polyposis of the stomach]].<ref name=pmid30584346>{{Cite journal | last1 = Rudloff | first1 = U. | title = Gastric adenocarcinoma and proximal polyposis of the stomach: diagnosis and clinical perspectives. | journal = Clin Exp Gastroenterol | volume = 11 | issue = | pages = 447-459 | month = | year = 2018 | doi = 10.2147/CEG.S163227 | PMID = 30584346 }}</ref> | |||
Note: | Note: | ||
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*Ulceration with heaped (raised) edges. | *Ulceration with heaped (raised) edges. | ||
**Appearance of the typical intestinal type tumour. | **Appearance of the typical intestinal type tumour. | ||
*Diffuse wall thickening with loss of the rugae - called ''linitis plastica''. | *Diffuse wall thickening with loss of the rugae - called ''[[linitis plastica]]''. | ||
**Typically due to diffuse carcinoma. | **Typically due to diffuse carcinoma. | ||
Main DDx of ulcer: | Main DDx of [[gastric ulcer]]: | ||
*[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa. | *[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa. | ||
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*[[Gastric xanthoma]] - may mimic signet ring cell carcinoma. | *[[Gastric xanthoma]] - may mimic signet ring cell carcinoma. | ||
*[[Neuroendocrine tumour]] - esp. for poorly differentiated; no gland formation. | *[[Neuroendocrine tumour]] - esp. for poorly differentiated; no gland formation. | ||
*Metastatic carcinoma. | |||
**[[Pancreatic ductal adenocarcinoma]]. | |||
*[[Gastric dysplasia]]. | |||
===Grading=== | ===Grading=== | ||
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==IHC== | ==IHC== | ||
*AE1/AE3. | |||
*CK7 +ve. | *CK7 +ve. | ||
*CK20 -ve, occasionally +ve. | *CK20 -ve, occasionally +ve. | ||
*[[CDX2]] +ve.<ref name=pmid12604886>{{Cite journal | last1 = Werling | first1 = RW. | last2 = Yaziji | first2 = H. | last3 = Bacchi | first3 = CE. | last4 = Gown | first4 = AM. | title = CDX2, a highly sensitive and specific marker of adenocarcinomas of intestinal origin: an immunohistochemical survey of 476 primary and metastatic carcinomas. | journal = Am J Surg Pathol | volume = 27 | issue = 3 | pages = 303-10 | month = Mar | year = 2003 | doi = | PMID = 12604886 }}</ref> | |||
Others: | Others: | ||
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**Poor prognosis - like in breast cancer. | **Poor prognosis - like in breast cancer. | ||
**Scoring system different than in breast cancer - complete membrane staining is not required. | **Scoring system different than in breast cancer - complete membrane staining is not required. | ||
==Staging== | |||
*Sixteen (or more) lymph nodes should be assessed (as per the 7th Ed. of the UICC/AJCC staging).<ref name=pmid24744586>{{Cite journal | last1 = Deng | first1 = JY. | last2 = Liang | first2 = H. | title = Clinical significance of lymph node metastasis in gastric cancer. | journal = World J Gastroenterol | volume = 20 | issue = 14 | pages = 3967-75 | month = Apr | year = 2014 | doi = 10.3748/wjg.v20.i14.3967 | PMID = 24744586 }}</ref> | |||
**The 5th Ed. of the UICC/AJCC staging manual stated 15 lymph nodes.<ref name=pmid24744586/> | |||
==Sign out== | ==Sign out== | ||
===Biopsy=== | ===Biopsy=== | ||
====Intestinal type==== | ====Intestinal type==== | ||
<pre> | |||
Stomach, Biopsy: | |||
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, moderately differentiated. | |||
- Gastric mucosa with intestinal metaplasia. | |||
Comment: | |||
The tumour stains as follows: | |||
POSITIVE: CK7, CDX2. | |||
NEGATIVE: CD20. | |||
HER2 testing has been ordered and will be reported as an addendum. | |||
</pre> | |||
<pre> | <pre> | ||
STOMACH, BIOPSY: | STOMACH, BIOPSY: | ||
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED. | - INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED. | ||
- Gastric mucosa with moderate chronic active inflammation and extensive | - Gastric mucosa with moderate chronic active inflammation and extensive | ||
intestinal metaplasia. | |||
- Benign small bowel mucosa with erosions. | - Benign small bowel mucosa with erosions. | ||
</pre> | </pre> | ||
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==See also== | ==See also== | ||
*[[Stomach]]. | *[[Stomach]]. | ||
*[[Siewert classification]]. | |||
==References== | ==References== | ||