Gastric cancer. EndoTODAY

[Gastric cancer 817. Small but aggressive gastric cancer]

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A 70 years old man was referred due to suspected gastric cancer although the initial biopsy was negative. The patient referral note was excellent.

Repeated biopsy after referral was poorly differentiated tubular adenocarcinoma, and surgical consultation was done

To my surprise, it was a very aggressive tumor invading the colon.

Stomach, subtotal gastrectomy: Advanced gastric carcinoma
1. Location : middle third, Center at mid body and greater curvature
2. Gross type : Borrmann type 3
3. Histologic type : tubular adenocarcinoma, poorly (poorly cohesive) differentiated
4. Histologic type by Lauren : diffuse
5. Size : 2.0x1.8 cm
6. Depth of invasion : invades adjacent organ (colon) (pT4b)
7. Resection margin: free from carcinoma, safety margin: proximal 4.3 cm, distal 14.5 cm
8. Lymph node metastasis : no metastasis in 18 regional lymph nodes (pN0) (0/18 : "3", 0/4; "4", 0/4; "5", 0/0; "6", 0/4; "7", 0/1; "9", 0/3; "8a", 0/1; "11p", 0/0; "12a", 0/1; "4sb", 0/0; "1", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Peritoneal cytology : negative
13. AJCC stage by 8th edition: pT4b N0
. Tumor present in serosa and proper muscle, "colon"

Thank you very much for the doctor Park. You did a really great job for the patient.