Atypical glands in the biopsy. EndoTODAY 이준행

[Gastric cancer 858. Atypical glands in the biopsy]

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A small IIa + IIc lesion was found in the screening endoscopy of a 70 years old woman. The biopsy report was atypical glands. Short-term follow up endoscopy was recommended but the patients was lost to follow-up.

2 years later, the woman visited the same endoscopy room. The lesion was bigger and there was an irregular ulcer in the middle. The biopsy was chronic ulcer with foveolar hyperplasia. PPI was given and short-term follow-up EGD was recommended.

4 weeks later, the size was similar, but ulcer part became uneven depressed lesion. The biopsy was "suspected tubular adenocarcinoma, well differentiated."

The elderly lady was referred to me. In the repeated endoscopic biopsy, it was "tubular adenocarcinoma, moderately differentiated." Surgical consultation was done

The surgical pathology was as followings.

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : lower third, Center at antrum and greater curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated, >> signet-ring cell carcinoma (30%)
4. Histologic type by Lauren : mixed
5. Size : 2.5x1.7 cm
6. Depth of invasion : invades submucosa (sm2) (pT1b)
7. Resection margin: free from carcinoma, safety margin: proximal 9.0 cm, distal 2.5 cm
8. Lymph node metastasis : no metastasis in 30 regional lymph nodes (pN0)
9. Lymphatic invasion : present
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT1b N0

It is difficult to think retrospectively, but there seems to be a chance of less invasive treatment (ESD, expanded indication) two years ago. Follow up examination is so important in some patients. However, the rate of follow up loss in quite high in the setting of national screening, which I worry a lot.

* Further reading: EndoTODAY atypical