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==Gastric adenocarcinoma==
==Gastric adenocarcinoma==
===General===
{{Main|Gastric carcinoma}}
Epidemiology:
*Prognosis is often poor as it is discovered at a late stage.
*Higher prevalence in countries in the far east (e.g. Japan) - thought to be environmental, e.g. diet.
 
Risk factors:
*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>
*Genetic syndromes - see [[hereditary gastric cancer]].
 
Note:
*Possible association with tobacco use - dependent on the study.<ref>{{Cite journal  | last1 = Nomura | first1 = A. | last2 = Grove | first2 = JS. | last3 = Stemmermann | first3 = GN. | last4 = Severson | first4 = RK. | title = Cigarette smoking and stomach cancer. | journal = Cancer Res | volume = 50 | issue = 21 | pages = 7084 | month = Nov | year = 1990 | doi =  | PMID = 2208177 | URL = http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=2208177}}</ref>
 
Treatment:
*Surgical excision. 
**Proximal tumours may require a complete gastrectomy as the stomach is innervated from its proximal part.
 
====Classification====
*Two different classification schemes.
**Lauren<ref name=pmid14320675>{{cite journal |author=LAUREN P |title=THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND  SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION |journal=Acta Pathol Microbiol Scand |volume=64 |issue= |pages=31–49 |year=1965 |pmid=14320675 |doi= |url=}}</ref> - two types:
***Intestinal type (mass forming).
***Diffuse type (infiltrative).
**WHO classification - 6 subtypes for adenocarcinoma:<ref name=Ref_PBoD823>{{Ref PBoD |823}}</ref>
**#Papillary carcinoma.
**#Tubular carcinoma.
**#Mucinous carcinoma.
**#Signet-ring carcinoma.
**#Undifferentiated carcinoma.
**#[[Adenosquamous carcinoma]].
 
Lame memory device ''STOMACH'':
*'''S'''ignet ring, '''T'''ubular, '''O'''h papillary, '''M'''ucinous, '''A'''denosquamouas, '''C'''rappy '''H'''igh grade (Undifferentiated).
 
===Gross===
Location:
*Large carcinomas preferentially involve the lesser curvature.<ref name=pmid2550682>{{Cite journal  | last1 = Yamagawa | first1 = H. | last2 = Onishi | first2 = T. | title = [A clinicopathological study of early gastric cancers with a diameter larger than five centimeters]. | journal = Gan No Rinsho | volume = 35 | issue = 10 | pages = 1114-8 | month = Sep | year = 1989 | doi =  | PMID = 2550682 }}</ref>
*Ulceration with heaped (raised) edges.
**Appearance of the typical intestinal type tumour.
*Diffuse wall thickening with loss of the rugae - called ''linitis plastica''.
**Typically due to diffuse carcinoma.
 
Main DDx of ulcer:
*[[Peptic ulcer disease]] - have a "punched-out" appearance: sharp edge, no granularity of surrounding mucosa.
 
====Images====
<gallery>
Image:Linitis_plastica.jpg | Linitis plastica - endoscopic image. (WC)
Image:Adenocarcinoma_of_the_stomach.jpg | Ulcerating gastric carcinoma. (WC)
Image:Adenocarcinoma,_stomach,_gross_pathology_IMG0037a_lores.jpg | Ulcerating gastric carcinoma. (WC)
</gallery>
 
===Microscopic===
Features - variable, either of the two following:
#"Typical adenocarcinoma":
#*Gland-forming lesion that infiltrates into the lamina propria or beyond.
#*Nuclear pleomorphism - common.
#+/-Signet ring carcinoma.
#*Scattered single cells in the lamina propria or beyond with:
#**Abundant cytoplasm containing one large (mucin-filled) vacuole.
#**A peripheral nucleus (displaced by the vacuole).
 
DDx:
*[[Gastric xanthoma]] - may mimic signet ring cell carcinoma.
*[[Neuroendocrine tumour]] - esp. for poorly differentiated; no gland formation.
 
====Grading====
*Moderately differentiated >=50 % glands.{{fact}}
*Poorly differentiated >=50% no glands (sheeting or nests).
 
====Images====
<gallery>
Image:Gastric_adenocarcinoma.jpg | Gastric adenocarcinoma. (WC)
Image:Gastric_signet_ring_cell_carcinoma_histopatholgy_%282%29_PAS_stain.jpg | Gastric SRC - PAS stain. (WC)
</gallery>
www:
*[http://path.upmc.edu/cases/case196.html Gastric adenocarcinoma - several images (upmc.edu)].
 
===Stains===
*Mucicarmine +ve.
 
===IHC===
*CK7 +ve.
*CK20 -ve, occasionally +ve.
 
Others:
*p53 +ve in upto 75% of cases.<ref name=pmid21772890>{{Cite journal  | last1 = Zali | first1 = MR. | last2 = Moaven | first2 = O. | last3 = Asadzadeh Aghdaee | first3 = H. | last4 = Ghafarzadegan | first4 = K. | last5 = Ahmadi | first5 = KJ. | last6 = Farzadnia | first6 = M. | last7 = Arabi | first7 = A. | last8 = Abbaszadegan | first8 = MR. | title = Clinicopathological significance of E-cadherin, β-catenin and p53 expression in gastric adenocarinoma. | journal = J Res Med Sci | volume = 14 | issue = 4 | pages = 239-47 | month = Jul | year = 2009 | doi =  | PMID = 21772890 }}</ref>
 
===Molecular===
*May have HER2 over expression - more common in intestinal-type tumours.<ref name=pmid22213295>{{Cite journal  | last1 = Romiti | first1 = A. | last2 = Di Rocco | first2 = R. | last3 = Milione | first3 = M. | last4 = Ruco | first4 = L. | last5 = Ziparo | first5 = V. | last6 = Zullo | first6 = A. | last7 = Duranti | first7 = E. | last8 = Sarcina | first8 = I. | last9 = Barucca | first9 = V. | title = Somatostatin receptor subtype 2 A (SSTR2A) and HER2 expression in gastric adenocarcinoma. | journal = Anticancer Res | volume = 32 | issue = 1 | pages = 115-9 | month = Jan | year = 2012 | doi =  | PMID = 22213295 }}</ref>
**Poor prognosis - like in breast cancer.
**Scoring system different than in breast cancer - complete membrane staining is not required.
 
===Sign out===
====Biopsy====
=====Intestinal type=====
<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL TYPE, MODERATELY DIFFERENTIATED.
- Gastric mucosa with moderate chronic active inflammation and extensive
  intestinal metaplasia.
- Benign small bowel mucosa with erosions.
</pre>
 
<pre>
GASTRIC ULCER, BIOPSY:
- INVASIVE ADENOCARCINOMA, INTESTINAL-TYPE, MODERATELY DIFFERENTIATED.
</pre>
 
=====Diffuse type=====
<pre>
STOMACH, BIOPSY:
- INVASIVE ADENOCARCINOMA, DIFFUSE TYPE.
 
COMMENT:
A pankeratin immunostain demonstrates single (infiltrating) epithelial cells in the
lamina propria.
</pre>
 
=====Micro=====
The tumour consists of single cells with abundant foamy-appearing cytoplasm and eccentric
nuclei with mild nuclear atypia.
 
=====Poorly differentiated=====
<pre>
GASTRIC ULCER, BIOPSY:
- INVASIVE ADENOCARCINOMA, POORLY-DIFFERENTIATED.
</pre>


=See also=
=See also=
Michael
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