An ill-defined undifferentiated type cancer. EndoTODAY 이준행

[Gastric cancer 846. An ill-defined undifferentiated type cancery]

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A patient was referred due to an EGC (histology: M/D). Repeated endoscopic biopsy was poorly differentiated adenocarcinoma. Would you try ESD?

Stomach, radical total gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : signet-ring cell carcinoma
4. Histologic type by Lauren : diffuse
5. Size : 2.0x1.9 cm
6. Depth of invasion : invades mucosa (lamina propria) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 3.3 cm, distal 9.5 cm
8. Lymph node metastasis : no metastasis in 47 regional lymph nodes (pN0)
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: pT1a N0

Selection of ESD candidate for EGC with undifferentiated type histology is very tricky. I think that a flat lesion around 1-1.5cm is the best condition right now. Expanding the indication in the near future is possible, but not now.