Guessing the depth of invasion. EndoTODAY

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[Gastric cancer 830. Guessing the depth of invasion]

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Guessing the depth of invasion is always difficult. What is your guess in this case?

The answer is an EGC. To my surprise, it was a mucosal cancer.

Stomach, subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and greater curvature
2. Gross type : EGC type IIb+IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated (40%) + signet ring cell carcinoma (60%)
4. Histologic type by Lauren : mixed
5. Size : 3.3x3 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.8 cm, distal 16.2 cm
8. Lymph node metastasis : no metastasis in 53 regional lymph nodes (pN0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : ulceration
13. AJCC stage by 8th edition: pT1a N0