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[Gastric cancer 831. Guessing the size]

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Guessing the size is sometimes not easy. What is your guess in this case?

A GI fellow endoscopist guessed as a 5cm EGC.

Early gastric cancer IIa+IIc
- Location : angle
- Size : 5 cm
- Angle에 mucosal thickenig이 관찰되며 표면이 hyperemic 하였고 angle 중앙은 nodular 하였음. PW 방향으로는 hematin이 붙어있었음. 경계가 불명확하여 dye spray 하였고, angle 전체를 involve 하는 elevated lesion이 관찰되며 LB LC 까지 involve 되어있었음 (img 41).

After pre-operative clipping, subtotal gastrectomy was done. The final pathologic size was 6.5cm. It was a larger mucosal cancer with lymph node metastasis at station 7 (left gastric node).

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, well differentiated, >> tubular adenocarcinoma, poorly (solid) differentiated (20%)
4. Histologic type by Lauren : mixed
5. Size : 6.5x4.0 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 6.5 cm
8. Lymph node metastasis : metastasis to 1 out of 25 regional lymph nodes (pN1) (perinodal extension: present) (1/25: "3", 0/10; "4", 0/7; "5", 0/0; "6", 0/2; "7", 1/3; "9", 0/2; "8a", 0/1; "11p", 0/0; "12a", 0/0; "4sb", 0/0; "1", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. Peritoneal cytology : negative
14. AJCC stage by 8th edition: pT1a N1

Hi! You did a good job.