위의 초고분화 선암의 진단적병리소견의 연구

Abstract

Background Extremely we differentiated adenocarcinoma (EWDA) is a deceptively bland-looking adenocarcinoma of the stomach. It often causes diagnostic problems, especially in endoscopic biopsy samples. To better recognize this tricky malignancy, we carefully reviewed a series of EWDAs treated at our institution. Design A total of 55 specimens from 19 patients were obtained. Gross and microscopic features defining EWDA were described and documented. For comparison, normal surrounding epithelium, regenerative atypia, hyperplastic polyp, and foveolar epithelial hyperplasia specimens were randomly selected and reviewed. Results Most cases (18 of 19, 94.7%) were advanced gastric cancer (AGC) and primarily located in the body of the stomach (15 of 19, 79.0%). The majority of AGCs were non-ulcerated (11 of 18, 61.1%) with an undermining pattern of invasion and relatively small mucosal involvement. Specific histologic features included an irregular glandular shape, an undulating apical cytoplasmic border, disproportionately large glands, irregularly spaced nuclei and a variably distended mucinous cytoplasm. Classical features, such as small infiltrating glands or desmoplastic reactions, were barely observed. Identification of disproportionately large glands against the surrounding normal glands, indicating glandular cancerization, as well as the atypical cytologic features described above was helpful for making a diagnosis from a biopsy sample. Such subtle signs of malignancy were missed in some of the preprocedural forceps biopsies (7 of 19, 37.0%). Conclusion Awareness of its histomorphologic characteristics that were described in this report would lead to a more timely diagnosis and would prevent repeated endoscopic procedures.