Intramucosal Gastric Carcinoma Research Articles

Magnifying endoscopy with narrow-band imaging is useful in differentiating gastric cancer from matched adenoma in white light imaging

This study assessed the effect of magnifying endoscopy with narrow-band imaging (M-NBI) on the endoscopic differential diagnosis between intramucosal gastric carcinomas and adenomas with matched characteristics. Associations between magnified endoscopic findings and pathological high-grade cellular and architectural atypia were also investigated. In total, the records of 50 adenomas and 50 intramucosal well-differentiated adenocarcinomas matched by tumor size (≥ 20 mm or < 20 mm), shape (depression or non-depression), and color (red or non-red) were extracted. Fourteen endoscopists diagnosed adenoma or cancer in the 100 cases with conventional white light imaging (C-WLI), then did the same with C-WLI + M-NBI.The cancer diagnostic sensitivity, specificity, and accuracy were assessed. The sensitivity of C-WLI + M-NBI for cancer diagnosis was 79.9% compared to 71.6% with C-WLI (p < 0.001). There were no significant differences in specificity (40.1% vs. 36.3%, p = 0.296) and accuracy (55.9% vs. 58.1%, p = 0.163). High-grade cytological or architectural atypia was diagnosed more often with irregular microvascular pattern (IMVP) or microsurface pattern (IMSP), respectively, than the low-grade forms. In conclusion, IMVP and IMSP correlate with high-grade cytological and architectural atypia. M-NBI is useful in differentiating intramucosal carcinoma from adenoma and can reduce underdiagnosis of cancer.

Expansion of Gastric Intestinal Metaplasia with Copy Number Aberrations Contributes to Field Cancerization.

This study contributes to our understanding of gastric intestinal metaplasia as a risk factor for gastric adenocarcinoma via their multifocal expansion and acquisition of CNAs and somatic mutations.

A case of synchronous intramucosal gastric carcinoma with multiple lymph node metastases

BackgroundIn Japan, the prevalence of synchronous multiple intramucosal gastric carcinoma is reported to be 5–15%. Here is a case of a synchronous small gastric carcinoma fulfilling the definite indication and curative criteria for endoscopic submucosal dissection with multiple lymph node metastases.Case presentationA Japanese woman in her fifties with a history of endoscopic resection for mucosal poorly differentiated adenocarcinoma was evaluated, with the UICC TNM classification stage being cT1aN0M0 cStageIA. She had undergone total gastrectomy with D1 + lymph node dissection. Histopathological examination revealed 16 individual sporadic lesions in the gastric body, with maximum diameter 3 mm and localization in the lamina propria. Twenty-seven nodes were resected, and metastasis of the carcinoma was revealed in 24 nodes.ConclusionsUndifferentiated intramucosal gastric cancer has a relatively high probability of lymph node metastasis; however, synchronous early lesions are often overlooked. Frequent follow-up examinations may increase the detection of multiple gastric cancers.

Risk-reducing total gastrectomy in asymptomatic CDH1 carriers

Hereditary diffuse gastric cancer is an autosomal dominant cancer susceptibility syndrome characterized by increased risk for gastric cancer and lobular breast cancer and mainly caused by germline alterations in the CDH1 gene. This was an observational, retrospective, and unicentric study. Clinical data from patients with hereditary diffuse gastric cancer who had risk-reducing total gastrectomy between June 2005 and January 2018 were collected. A thorough histopathological analysis of gastrectomy specimens was performed, according to the current recommendations of the International Gastric Cancer Linkage Consortium. In 59 families fulfilling the clinical criteria for CDH1 testing, we identified the same CDH1 missense pathogenic variant in five families. Thirty-nine CDH1 carriers were identified. Four CDH1 carriers died with advanced diffuse gastric cancer, 19 chose risk-reducing total gastrectomy, and 16 opted for endoscopic surveillance, despite being duly informed of the limited utility of periodic gastric endoscopy in this context. The 19 asymptomatic CDH1 carriers undergoing surgery had an age range of 14–63 years (median, 39 years) and the median hospital stay was 6 days. Laparoscopic total gastrectomy was performed on four of 19 CDH1 carriers. There were no cases of mortality or major morbidity in this procedure. The range of weight loss in our series was 13%. Histopathological examination of the entirety of gastric mucosa revealed intramucosal gastric carcinoma foci (pT1a) in 17 of 19 (89.5%) total gastrectomy specimens. No lymph node metastases were detected (pN0). Risk-reducing total gastrectomy remains the best clinical management for patients with hereditary diffuse gastric cancer harboring a germline, pathogenic CDH1 variant. In our series, intramucosal carcinoma foci were found in the great majority (89.5%) of CDH1 carriers.

Calcium Carbonate Nanoparticles Can Activate the Epithelial⁻Mesenchymal Transition in an Experimental Gastric Cancer Model.

Previously, we have shown the possibility of intramucosal gastric carcinoma induction by the intragastric administration of a mixture of formaldehyde and hydrogen peroxide in rats. In this study, we report a sizable increase in carcinogenic properties of the mixture when a suspension containing calcium carbonate nanoparticles was added to it. This technique allowed us to reduce both the number of the carcinogen administrations from twelve to two and the time to the cancer induction from six to four months. Although the induced tumors were represented by the intramucosal carcinomas, they were characterized by the extensive invasion of individual tumor cells and their clusters into the muscle layer and serosa as well as into the omentum and blood vessels. Considering that the invasive tumor cells were positive for vimentin, Snail and TGF-β2, we concluded that their invasion was the result of the activation of epithelial–mesenchymal transition (EMT) mechanisms. Thus, taking into account the data obtained, it can be assumed that under the conditions of inflammation or carcinogenesis, the calcium carbonate nanoparticles may affect the activation of EMT mechanisms.

Identification of early genetic changes in well-differentiated intramucosal gastric carcinoma by target deep sequencing

The recent advancement of next-generation sequencing (NGS) has enabled the identification of cancer-related somatic aberrations in advanced gastric cancer. However, these remain unclear in early gastric cancers, especially in intramucosal gastric cancers. Thirty-one well-differentiated (tub1) intramucosal gastric cancers obtained by endoscopic submucosal dissection (ESD) from 29 patients were analyzed. After precise collection of tumors and non-tumors from formalin-fixed paraffin-embedded tissues using laser-captured microdissection (LCM), target sequencing analysis of 50 cancer-related genes was performed using an Ion-Proton sequencer. The most frequent hotspot mutation was found in TP53 (17 lesions, 54.8%) followed by the Wnt-signaling pathway genes, APC and CTNNB1 (6 lesions, 19.4%). The mutations in TP53 and the Wnt-signaling genes were mutually exclusive (p = 0.004). There was a tendency that H. pylori infection (p = 0.082) and macroscopic protrusion (p = 0.095) was associated with the presence of these mutations. Only 10 lesions (59%) among 17 lesions with proven TP53 mutations were positive for p53 immunostaining demonstrating the superiority of the mutational analysis. In addition, focal gene amplification of ERBB2 (16%) was found frequently in these early stage lesions. Using LCM and NGS, mutations in TP53 and the Wnt-signaling pathway were frequently found and were mutually exclusive in the earliest stage of gastric carcinogenesis.

Incidental Finding of Intramucosal Signet Ring Cell Gastric Carcinoma

Incidental Finding of Intramucosal Signet Ring Cell Gastric Carcinoma

Genetic features of multicentric/multifocal intramucosal gastric carcinoma.

Chronic gastritis caused by Helicobacter pylori (H. pylori) infection could lead to the development of gastric cancer. The finding that multiple gastric cancers can develop synchronously and/or metachronously suggests the development of field cancerization in chronically inflamed, H. pylori-infected gastric mucosa. The genetic basis of multiple tumorigenesis in the inflamed stomach, however, is not well understood. In this study, we analyzed the microsatellite instability (MSI) status and copy number aberrations (CNAs) of 41 multiple intramucosal early gastric cancers that synchronously or metachronously developed in 19 patients with H. pylori infection. Among the 41 intramucosal gastric carcinomas, 9 (22%) exhibited MSI, and the remaining 32 (78%) exhibited the microsatellite stable (MSS) phenotype. Metachronous multiple intramucosal gastric carcinoma exhibit inter-tumor heterogeneity by individually acquiring genetic aberrations. All synchronous multiple intramucosal gastric carcinoma pairs shared a common MSI/MSS profile, and CNA analysis revealed that synchronous multiple intramucosal gastric carcinoma pairs with the MSS phenotype shared common aberrations of representative tumor-suppressor genes, including focal deletion of APC, TP53, CDKN2A, and CDKN2B. Multiregional CNA analysis revealed that heterogeneous gene amplifications/deletions, including PDL1 amplification, evolved under the presence of shared "trunk" genetic alterations in a subpopulation of individual intramucosal gastric carcinomas. These data suggest that multiple gastric carcinomas develop in a multicentric/multifocal manner exhibiting features of inter- and intra-tumor heterogeneity in H. pylori-infected gastric mucosa, whereas synchronous multiple intramucosal gastric carcinomas could share partially common genetic alterations, possibly via common oncogenic pathways.

Laparoscopic and endoscopic cooperative surgery for intra-mucosal gastric carcinoma adjacent to the ulcer scars

BackgroundLaparoscopic and endoscopic cooperative surgery (LECS) was performed for the local resection of gastrointestinal stromal tumors (GIST). LECS enables less resection of the lesion area and preserves function. Furthermore, LECS can be safely performed and independent of tumor location. However, LECS is not usually used for cases involving gastric carcinoma because it may seed tumor cells into the peritoneal cavity when the gastric wall is perforated. Here, we report seven cases of LECS for intra-mucosal gastric carcinoma, which were difficult to carry out by endoscopic submucosal dissection (ESD) because of ulcer scars.MethodsWe performed LECS (classical LECS and inverted LECS) in seven cases of intra-mucosal gastric carcinoma. All cases had ulcer scars beside the tumor. LECS was chosen because ESD was thought to be difficult because of the ulcer scars. We only selected cases in which the patients did not prefer gastrectomy and endoscopic examination was indicative of intra-mucosal gastric carcinoma.ResultsIn all cases, LECS was performed without severe complications including postoperative stenosis. Histopathology findings proved that the tumors were intra-mucosal carcinoma and had been resected completely. Furthermore, there were ulcer scars (Ul IIIs-IVs) beside the tumor. Currently, dissemination and recurrence have not been apparent.ConclusionsLECS for intra-mucosal gastric carcinoma is an efficient procedure, but strict observation is necessary because of the possibility of peritoneal dissemination. Results suggest that LECS is likely to be effective for cases involving intra-mucosal gastric carcinoma that are difficult to treat by ESD due to ulcer scars.

Somatic mutations and increased lymphangiogenesis observed in a rare case of intramucosal gastric carcinoma with lymph node metastasis.

Background and aimIntramucosal gastric adenocarcinoma of the well-moderately differentiated type only exhibits lymph node metastasis in extremely rare cases. We encountered such case and investigated both the lymphangiogenic properties and somatic mutations in the cancer to understand the prometastatic features of early-stage gastric cancer.MethodsWe quantitatively measured the density of lymphatic vessels and identified mutations in 412 cancer-associated genes through next-generation target resequencing of DNA extracted from tumor cells in a formalin-fixed and paraffin-embedded tissue. Functional consequence of the identified mutation was examined in vitro by means of gene transfection, immunoblot, and the quantitative real-time polymerase chain reaction assay.ResultsThe intramucosal carcinoma was accompanied by abundant lymphatic vessels. The metastatic tumor harbored somatic mutations in NBN, p.P6S, and PAX8, p.R49H. The PAX8R49H showed significantly higher transactivation activity toward E2F1 than the wild-type PAX8 (P< 0.001).ConclusionsOur data suggest that increased lymphangiogenesis and somatic mutations of NBN and/or PAX8 could facilitate lymph node metastasis from an intramucosal gastric carcinoma. These findings may potentially inform evaluations of the risk of developing lymph node metastasis in patients with intramucosal gastric cancer.

Progression risk assessments of individual non-invasive gastric neoplasms by genomic copy-number profile and mucin phenotype.

BackgroundEarly detection and treatment of non-invasive neoplasms can effectively reduce the incidence of advanced gastric carcinoma (GC), but only when the lineage is continuous between non-invasive and advanced tumours. Although a fraction of non-invasive neoplasms progress to invasive GC, it is difficult to identify individual progression-prone non-invasive neoplasms. To classify non-invasive gland-forming gastric neoplasms into clusters of different levels of progression risk, we applied mucin phenotyping and genomic DNA microarray analyses to intramucosal gland-forming gastric neoplasms.MethodsFormalin-fixed, paraffin-embedded tissues from 19 non-invasive and 24 invasive gland-forming neoplasms were obtained via endoscopic submucosal dissection or surgical excision. According to the Vienna classification, intramucosal neoplasms were classified as low-grade or high-grade non-invasive neoplasms (LGNs [category 3] and HGNs [category 4], respectively) or invasive carcinomas (intramucosal GCs and mucosal parts of submucosal or deeper GCs [category 5]). Neoplastic lesions were characterized by mucin phenotypes determined using monoclonal antibodies against MUC2, MUC5AC, MUC6, and CD10. Genomic DNA samples from mucosal neoplasms were subjected to array-based comparative genomic hybridization and subsequent unsupervised, hierarchical clustering with selected large-sized genes.ResultsThere was no significant difference in mucin phenotype between HGNs/LGNs and invasive carcinomas. The clustering classified samples into stable, unstable, and intermediate. The histological tumour grade or mucin phenotype of non-invasive neoplasms did not correlate with the clustering results. Each cluster may represent an independent lineage of different outcome because the size distribution of non-invasive tumours among the 3 clusters almost overlapped. In contrast, the unstable cluster alone included invasive carcinomas.ConclusionsThese findings suggest that the outcome of individual tumours is not stochastically determined but can be predicted from the genomic copy-number profile even at the non-invasive stage. Non-invasive neoplasms of the unstable clusters, which accounted for 21% of non-invasive neoplasms, may progress to invasive carcinomas, whereas those of stable cluster may not.Electronic supplementary materialThe online version of this article (doi:10.1186/s12920-015-0080-6) contains supplementary material, which is available to authorized users.

A Krukenberg Tumor from an Occult Intramucosal Gastric Carcinoma Identified during an Autopsy

A healthy 45-year-old Japanese female developed right pleural effusion, ascites, and a pelvic mass. Bilateral salpingo-oophorectomy resolved the pleural effusion and ascites. Histopathological examination of the ovaries showed bilateral Krukenberg tumors with signet-ring cell carcinoma (SRCC). Extensive testing including upper and lower gastrointestinal endoscopy and whole-body imaging did not detect the primary lesion. Six months after bilateral salpingo-oophorectomy, the patient developed multiple osteoblastic bone lesions in the spine, pelvis, and femurs. A biopsy of the bone marrow showed SRCC. We administered four cycles of S-1 and cisplatin, resulting in the shrinkage of osteoblastic lesions; she remained stable for a year. Then, she developed disseminated intravascular coagulation with disease progression in the bones. Although she was treated with paclitaxel, the disseminated intravascular coagulation progressed, and she died in a month. During the autopsy, microscopic examination revealed four foci of intramucosal gastric SRCC and healthy macroscopic gastric mucosa.

Synchronous appendiceal and intramucosal gastric signet ring cell carcinomas in an individual with CDH1-associated hereditary diffuse gastric carcinoma: a case report of a novel association and review of the literature

BackgroundHereditary diffuse gastric carcinoma is an autosomal dominant cancer syndrome associated with mutations of the E-cadherin gene (CDH1). E-cadherin is normally involved in cell-cell adhesion, so it not surprising that individuals with this syndrome are predisposed to develop malignancies with dyshesive morphologies at a young age, such as diffuse (signet ring cell) gastric carcinoma and lobular breast carcinoma. Herein we describe the first reported case of primary appendiceal signet ring cell carcinoma arising in a CDH1-associated hereditary diffuse gastric carcinoma kindred with synchronous primary diffuse gastric carcinoma.Case presentationA 51- year old woman, with known CDH1 mutation carrier status and a prior history of lobular breast carcinoma underwent prophylactic total gastrectomy which revealed multifocal intramucosal signet ring cell carcinoma. An appendectomy was performed at the same time due to a prior episode of presumed appendicitis, with pathologic examination significant for a primary signet ring cell carcinoma of the appendix.ConclusionAs appendiceal signet ring cell carcinoma is exceedingly rare, the occurrence of this neoplasm in this patient, with this particular morphology, provides credence for it being part of the hereditary diffuse gastric carcinoma spectrum of malignancies.

Mo1571 Risk Stratification for Gastric Cancer Using Serum Pepsinogen and Helicobacter pylori Serology in a Chinese Population

Background: Several studies have evaluated various histologic predictors of invasion in breast and colon cancer biopsies. However, possible predictive factors of submucosal invasion in early gastric carcinomas have not been investigated. Identifying pathologic factors to predict submucosa invasion from pretreatment gastric biopsies would help select patients who may benefit from endoscopic mucosal resection (EMR). Methods: Pretreatment gastric biopsies from 60 patients with early gastric carcinomas with submucosal invasion who underwent EMR between 2002 and 2007 were reviewed. As a control, biopsies from 58 patients with intramucosal gastric carcinomas taken during the same period were evaluated. For validation of the results, another 702 gastric biopsies treated and confirmed as pT1 gastric carcinomas were also reviewed. For statistical analyses, Chi-square test, Fisher's exact test using permutation method for multiple testing, and multiple logistic progression tests were used. Results: The depth of submucosa invasion varied from 50 μm to 3000 μm (mean 949 μm). In the biopsy specimens of carcinoma with submucosa invasion, differentiated histology, histologic heterogeneity, islands of muscularis mucosa, cribriform pattern, papillary feature, desmoplastic reaction, and intraglndular eosinophilic necrotic debris (IEND) were observed in 96.7%, 36.7%, 16.7%, 16.7%, 23.3%, 40%, and 46.7% of cases, respectively, compared to 100%, 5.2%, 0%, 1.7%, 5.2%, 19%, and 22.4% of intramucosal carcinoma biopsies. In multivariable analyses, histologic heterogeneity [odds ratio (OR), 9.59, p=0.002], IEND [OR, 6.23, p= 0.012], cribriform pattern [OR, 4.66, p=0.03], and papillary feature [OR, 5.52, p=0.018] were significantly associated with submucosal invasion in EMR specimens. In the validation cohort, histologic heterogeneity remained significant (p=0.003) with 48.7% sensitivity and 72.2% specificity, with positive predictive value of 43.5% [95% confidence interval (36.9%, 50.1%)] and negative predictive value of 75.3% [95% confidence interval (71.1%, 79.5%)]. Conclusion: In pretreatment gastric biopsies, histologic heterogeneity is a significant pathologic predictor of submucosal invasion. Additional prospective studies are warranted to find more sensitive and specific markers.

Mo1569 MicroRNA-21 Expression Causes Nuclear Loss of the Tumor Suppressor PDCD4 in Precancerous Gastric Adenomas

Background: Several studies have evaluated various histologic predictors of invasion in breast and colon cancer biopsies. However, possible predictive factors of submucosal invasion in early gastric carcinomas have not been investigated. Identifying pathologic factors to predict submucosa invasion from pretreatment gastric biopsies would help select patients who may benefit from endoscopic mucosal resection (EMR). Methods: Pretreatment gastric biopsies from 60 patients with early gastric carcinomas with submucosal invasion who underwent EMR between 2002 and 2007 were reviewed. As a control, biopsies from 58 patients with intramucosal gastric carcinomas taken during the same period were evaluated. For validation of the results, another 702 gastric biopsies treated and confirmed as pT1 gastric carcinomas were also reviewed. For statistical analyses, Chi-square test, Fisher's exact test using permutation method for multiple testing, and multiple logistic progression tests were used. Results: The depth of submucosa invasion varied from 50 μm to 3000 μm (mean 949 μm). In the biopsy specimens of carcinoma with submucosa invasion, differentiated histology, histologic heterogeneity, islands of muscularis mucosa, cribriform pattern, papillary feature, desmoplastic reaction, and intraglndular eosinophilic necrotic debris (IEND) were observed in 96.7%, 36.7%, 16.7%, 16.7%, 23.3%, 40%, and 46.7% of cases, respectively, compared to 100%, 5.2%, 0%, 1.7%, 5.2%, 19%, and 22.4% of intramucosal carcinoma biopsies. In multivariable analyses, histologic heterogeneity [odds ratio (OR), 9.59, p=0.002], IEND [OR, 6.23, p= 0.012], cribriform pattern [OR, 4.66, p=0.03], and papillary feature [OR, 5.52, p=0.018] were significantly associated with submucosal invasion in EMR specimens. In the validation cohort, histologic heterogeneity remained significant (p=0.003) with 48.7% sensitivity and 72.2% specificity, with positive predictive value of 43.5% [95% confidence interval (36.9%, 50.1%)] and negative predictive value of 75.3% [95% confidence interval (71.1%, 79.5%)]. Conclusion: In pretreatment gastric biopsies, histologic heterogeneity is a significant pathologic predictor of submucosal invasion. Additional prospective studies are warranted to find more sensitive and specific markers.

Differentiated intramucosal gastric carcinoma without ulceration showing extensive lymph node metastasis

Early gastric cancer is defined as gastric cancer confined to the mucosa or submucosa. For the majority of early gastric cancers without nodal involvement, endoscopic mucosal removal (EMR) is safer and more cost-effective than are other treatment methods. Here we report a rare case of differentiated mucosal carcinoma with extensive lymphovascular invasion and lymph node metastasis. Endoscopy showed a 5.5 cm non-ulcerated slightly elevated and depressed lesion without indication of submucosal involvement. Although the tumor met the extended criteria for EMR, D2 gastrectomy was performed. The resected specimen showed a 5.5 cm intramucosal carcinoma with extensive lymphovascular invasion of the submucosa, and metastasis to two perigastric nodes, indicating that metastasis can occur in patients with non-ulcerated differentiated mucosal tumors. Although these tumors are extremely rare, the risks and limitations of EMR should be fully considered in choosing an optimal surgical procedure.

Analysis of Endoscopic Electronic Image of Intramucosal Gastric Carcinoma Using a Software Program for Calculating Hemoglobin Index

Analysis of Endoscopic Electronic Image of Intramucosal Gastric Carcinoma Using a Software Program for Calculating Hemoglobin Index

Analysis of Electronic Endoscopic Image of Intramucosal Gastric Carcinoma Using Hemoglobin Index

It has been suggested that the endoscopic color of intramucosal gastric carcinoma is correlated with mucosal vascularity within the carcinomatous tissue. The development of electronic endoscopy has made it possible to quantitatively measure the mucosal hemoglobin volume, using a hemoglobin index. The aim of this study was to make a software program to calculate the hemoglobin index (IHb) and then investigate whether the mucosal IHb determined from the electronic endoscopic data is a useful marker for evaluating the color of intramucosal gastric carcinoma, in particular with regard to its value for discriminating between the histologic types. The mean values of IHb for the carcinoma (IHb-C) and the mean values of IHb for the surrounding non-cancerous mucosa (IHb-N) were calculated in 75 intestinal-type and 34 diffuse-type gastric carcinomas. Then, we analyzed the ratio of the IHb-C to IHb-N. The mean IHb-C/IHb-N ratio in the intestinal-type carcinoma group was higher than that in the diffuse-type carcinoma group (1.28<TEX>$\pm$</TEX>0.19 vs. 0.81<TEX>$\pm$</TEX>0.18, respectively, p<0.001). When the cut-off point of the C/N ratio was set at 1.00, the accuracy rate, the sensitivity, the specificity, and the positive and negative predictive values of a C/R ratio below 1.00 for the differential diagnosis of diffuse-type carcinoma from intestinal-type carcinoma were 94.5%, 94.1%, 94.7%, 88.9% and 97.3%, respectively. IHb is useful for quantitative measurement of the endoscopic color in intramucosal gastric carcinoma and the IHb-C/IHb-N ratio would be helpful in distinguishing diffuse-type carcinoma from intestinal-type carcinoma.

Analysis of Endoscopic Electronic Image of Intramucosal Gastric Carcinoma Using a Software Program for Calculating Hemoglobin Index

Hemoglobin is the predominent pigment in the gastrointestinal mucosa, and the development of electronic endoscopy has made it possible to quantitatively measure the mucosal hemoglobin volume, by using a hemoglobin index (IHb). The aims of this study were to make a software program to calculate the IHb and then to investigate whether the mucosal IHb determined from the electronic endoscopic data is a useful marker for evaluating the color of intramucosal gastric carcinoma with regard to its value for discriminating between the histologic types. We made a software program for calculating the IHb in the endoscopic images. By using this program, the mean values of the IHb for the carcinoma (IHb-C) and those of the IHb for the surrounding non-cancerous mucosa (IHb-N) were calculated in 75 intestinal-type and 34 diffuse-type intramucosal gastric carcinomas. We then analyzed the ratio of the IHb-C to the IHb-N (C/N ratio). The C/N ratio in the intestinal-type carcinoma group was higher than that in the diffuse-type carcinoma group (p<0.001). In the diffuse-type carcinoma group, the C/N ratio in the body was lower than that in the antrum (p=0.022). The accuracy rate, sensitivity, specificity, and the positive and negative predictive values for the differential diagnosis of the diffuse-type carcinoma from the intestinal-type carcinoma were 94.5%, 94.1%, 94.7%, 88.9% and 97.3%, respectively. IHb is useful for making quantitative measurement of the endoscopic color in the intramucosal gastric carcinoma, and the C/N ratio by using the IHb would be helpful for distinguishing the diffuse-type carcinoma from the intestinal-type carcinoma.

Recurrent Intramucosal Gastric Carcinoma with Extensive Invasion to Duodenal Mucosa after Endoscopic Mucosal Resection: A Case Report

The occurrence of early gastric carcinoma with invasion to the duodenum is supposed to be very low, although advanced cancers arising in the antrum can often invade the duodenal area. Generally, malignant invasion of the duodenum is difficult to diagnose preoperatively, as spread of gastric cancer to the duodenum is often infiltrative and invades through the submucosal or subserosal layer. We report an unusual case of an intramucosal gastric carcinoma with extensive duodenal invasion that was preoperatively diagnosed by endoscopy.