EGC or AGC. Issue of SM3-massive. EndoTODAY 이준행

[Gastric cancer 877. EGC or AGC - issue of SM3-massive]

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This patient was referred for the endoscopic treatment of an ill-defined lesion at the gastric angle. The initial biopsy before the referral was adenoma with high grade dysplasia.

Initial endoscopy

Because the margin of the lesion is vague, I repeated the endoscopic examination.

Repeated endoscopy.

The long diameter of the lesion was 6 cm and the endoscopic biopsy was moderately differentiated adenocarcinoma. In addition, the lesion looked like a flat elevated lesion with slightly nodular surface and a few erosions on the top rather than the EGC IIa or EGC IIb. I recommended surgery.

Stomach, radical subtotal gastrectomy: Advanced gastric carcinoma
1. Location : lower third, Center at antrum and anterior wall
2. Gross type : Borrmann type unclassifiable (mimicking EGC type IIc)
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size : 6.5x4.0 cm
6. Depth of invasion : invades muscularis propria (pT2) (see note)
7. Resection margin: free from carcinoma, safety margin: proximal 2.6 cm, distal 2.3 cm
8. Lymph node metastasis : no metastasis in 36 regional lymph nodes (pN0) (perinodal extension: absent) (0/36: 3,5, 0/18; 4,6, 0/5; "1", 0/0; "5", 0/2; "6", 0/4; "7", 0/1; "9", 0/0; "8a", 0/2; "11p", 0/1; "12a", 0/3; "4sb", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 8th edition: pT2 N0
Note: This carcinoma can be classified as SM3-massive by Japanese classification.

The pathology note is very unusual. Japanese pathologists are different from pathologists in other countries.

[우리말 註] 우리나라에서는 AGC이고 일본에서는 EGC라는 것이 말이나 됩니까? 현실에서는 말이 됩니다. 일본은 참 이상한 나라입니다.

조기위암과 진행성위암의 구분에도 국가간 차이가 있습니다. 이 증례가 전형적인 예입니다. 2021년 6월 4일 병리과 안수민 선생님을 모시고 제2회 내시경 병리 세미나를 진행하면서 SM3 massive에 대하여 논의하였습니다.

* 참고: EndoTODAY 위암 122 SM3-massive papillary adenocarcinoma