Multiple Early Gastric Cancer Research Articles

Endoscopic Features of Synchronous Multiple Early Gastric Cancers: Findings from a Nationwide Cohort

Introduction: We investigated the factors associated with synchronous multiple early gastric cancers and determined their localization. Methods: We analyzed 8,191 patients who underwent endoscopic submucosal dissection for early gastric cancers at 33 hospitals in Japan from November 2013 to October 2016. Background factors were compared between single-lesion (n = 7,221) and synchronous multi-lesion cases (n = 970) using univariate and multivariate analyses. We extracted cases with two synchronous lesions (n = 832) and evaluated their localization. Results: Significant independent risk factors for synchronous multiple early gastric cancer were older age (≥75 years old) (odds ratio [OR] = 1.257), male sex (OR = 1.385), severe mucosal atrophy (OR = 1.400), tumor localization in the middle (OR = 1.362) or lower region (OR = 1.404), and submucosal invasion (OR = 1.528 [SM1], 1.488 [SM2]). Depressed macroscopic type (OR = 0.679) and pure undifferentiated histology OR = 0.334) were more common in single early gastric cancers. When one lesion was in the upper region, the other was more frequently located in the lesser curvature of the middle region. When one lesion was in the middle region, the other was more frequently located in the middle region or the lesser curvature of the lower region. When one lesion was in the lower region, the other was more frequently located in the lesser curvature of the middle region or the lower region. Conclusion: Factors associated with synchronous multiple early gastric cancer included older age, male sex, severe mucosal atrophy, tumor localization in the middle or lower region, and tumor submucosal invasion. Our findings provide useful information regarding specific areas that should be examined carefully when one lesion is detected.

Characteristics of multiple early gastric cancer and gastric high-grade intraepithelial neoplasia.

This study evaluated the clinical characteristics of multiple early gastric cancer (MEGC) and high-grade intraepithelial neoplasia (HGIN) treated by endoscopic submucosal dissection. The clinical profiles of 23 patients with MEGC treated by endoscopic submucosal dissection from January 2008 to June 2019 at the Fujian Provincial Hospital or Fujian Provincial Hospital South Branch were analyzed. The following information was extracted from clinical records: general data, preoperative conditions, and pathological data of each lesion after surgery. In total, 23 patients with MEGC or HGIN were evaluated (average age 64 ± 6 years, 17 (73.9%) males). MEGC and HGIN accounted for 4.9 percent of all cases, in which 19 (4.1%) were synchronous multiple cancers and 4 (0.8%) cases were metachronous multiple cancers. Lesions of synchronous and metachronous MEGC groups did not differ in age, sex, smoking history, alcohol consumption, family history of tumors, Helicobacter pylori infection, mucosal background atrophy, or intestinal metaplasia (P > .05). The vertical locations of primary and secondary lesions of MEGC were correlated (R = 0.395, P = .034). The primary and secondary lesions of MEGC shared the same macroscopic subtype (R = 0.590, P = .015), infiltration depth (R = 0.455, P = .014), and pathological subtype (R = 0.736, P < .001). MEGC and HGIN were located in close proximity. Pathologic types tended to be low-grade malignancies. The macroscopic type, histology type, and infiltration depth of the 2 lesions were significantly correlated. When detecting early gastric cancer, we should inspect the stomach and carefully consider the pathological characteristics, to improve the diagnosis of MEGC.

Comparison of clinical outcomes and prognosis between surgery and endoscopic submucosal dissection in patients with synchronous multifocal early gastric cancer

BackgroundSynchronous multiple early gastric cancer (SMEGC) refers to the simultaneous occurrence of two or more malignant cancer lesions in the stomach. For patients with multiple early gastric carcinomas, the choice of appropriate treatment remains controversial. This study is dedicated to comparing the clinical outcomes and prognosis of patients with SMEGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy.MethodsA total of 180 patients with more than one malignant cancer lesion in the stomach who had received gastrectomy or ESD between 2012 and 2021 were retrospectively evaluated to determine their clinical outcomes and prognosis. Univariate and multivariate logistic regression were utilized to identify risk factors for tumor recurrence.ResultsOver the 57.5 months median follow-up period for the 140 enrolled cases, tumor recurrence occurred in 8 (12%) in the ESD group but only 1 (1%) in the surgery group. Relapse-free survival (RFS) was higher in the surgery group (p = 0.023) in all cases; however, there was no significant difference in Overall survival (OS, p = 0.772). Complications were significantly higher in the surgery group than in the ESD group, but fewer in the radical distal gastrectomy group. Multivariate regression analysis revealed that ESD(p = 0.034), the main lesion size > 2 cm(p = 0.019), and undifferentiated tumor(p = 0.022) were independent risk factors for tumor recurrence.ConclusionsFor the treatment of simultaneous multifocal early gastric cancer, ESD has a good short-term effect and higher quality of life. However, ESD has a higher risk of recurrence than surgery. And we found that the partial gastrectomy appears to be considered as adequate treatment for some SMEGC patients.

Endoscopic Screening for Missed Lesions of Synchronous Multiple Early Gastric Cancer during Endoscopic Submucosal Dissection.

To evaluate the value of endoscopic screening during endoscopic submucosal dissection (ESD) in the detection of synchronous multiple early gastric cancer (SMEGC) and the risk factors for missed diagnosis of SMEGC. We conducted gastric endoscopic screening during ESD operation in 271 patients with early gastric cancer (EGC) referred for ESD, and endoscopic follow-up within 1 year after the operation. The detection and characteristics of SMEGC were analyzed in three stages: before ESD, during ESD operation, and within 1 year after ESD. SMEGC was detected in 37 of 271 patients (13.6%). Among them, 21 patients with SMEGC (56.8%) were diagnosed before ESD, 9 (24.3%) were diagnosed with SMEGC by endoscopic screening during ESD operation, and 7 (18.9%) were found to have EGC lesions in the stomach during postoperative endoscopic follow-up within 1 year. The preoperative missed detection rate of SMEGC was 43.2%, and the rate of missed detection could be reduced by 24.3% (9/37) with endoscopic screening during ESD operation. Missed SMEGC lesions were more common in flat or depressed type and smaller in size than the lesions found before ESD. The presence of severe atrophic gastritis and age ≥60 years were significantly correlated with SMEGC (P < 0.05), while multivariate analysis showed that age ≥60 years was an independent risk factor (OR = 2.63, P < 0.05) for SMEGC. SMEGC lesions are apt to be missed endoscopically. Special attention should be paid to small, depressed, or flat lesions in detecting SMEGC, especially in elderly patients or (and) patients with severe atrophic gastritis. Endoscopic screening during ESD operation can effectively reduce the missed diagnosis rate of SMEGC.

A case of simultaneous laparoscopic surgery for double cancer comprising multiple early gastric cancer and advanced sigmoid colon cancer after revascularization

BackgroundTraditionally, the surgery for simultaneous double cancer of the stomach and colon required a large incision to the upper and lower region of the abdomen. In this case, an artificial blood vessel was located under the skin after revascularization. Considering ischemia due to graft compression by incision retractor during laparotomy, this was difficult to do. This is a report on laparoscopic surgery for simultaneous double cancer of the stomach and colon after revascularization.Case presentationA 69-year-old man had early gastric cancer and advanced sigmoid colon cancer. He had suffered from thromboangitis obliterans and has undergone revascularization many times due to poor blood flow in his lower limbs. He had had some artificial blood vessels inserted under the skin, confirmed by blood vessel construction image by preoperative computed tomography (CT). There was a bypass vessel from the left axillary artery to the left femoral artery under the skin of the left thoracoabdominal. In addition, there were two bypass vessels from the left external iliac artery to the right femoral artery under the skin of the lower abdomen. One of the two bypasses was occluded. In the blood flow to the intestinal tract, the inferior mesenteric artery was already occluded. Peripheral blood flow in the common iliac artery depended on blood flow from the artificial blood vessel, and blood flow from the internal iliac artery to the rectum was poor. Laparoscopic Hartmann’s operation was performed for Stage II B (UICC 8th Edition) sigmoid colon cancer. Because the blood flow in the intestinal tract on the anal side was poor, we thought that anastomosis was at a high risk for leakage. Laparoscopic total gastrectomy was also performed simultaneously for two Stage I (UICC 8th edition) gastric cancers in the cardia and body. The location of the port site and stoma was carefully determined preoperatively to prevent damage and infection to the artificial blood vessels. Minimal invasive surgery was performed using laparoscopic surgery.ConclusionsLaparoscopic surgery with small incisions is useful for patients with double cancer who need an approach to the upper and lower abdomen. Furthermore, laparoscopic surgery has less interference on graft in patients with artificial blood vessels under the skin by intraperitoneal approach.

A Case Of Multiple Early Gastric Cancers With Diffuse Cystic Malformation Successfully Diagnosed By Ultrasound Endoscopy

A Case Of Multiple Early Gastric Cancers With Diffuse Cystic Malformation Successfully Diagnosed By Ultrasound Endoscopy

Clinicopathological features, risk of lymph node metastasis and survival outcome of synchronous multiple early gastric cancer

To determine clinicopathological features, risk of lymph node metastasis (LNM) and survival outcome in synchronous multiple early gastric cancer (MEGC) patients. A total of 338solitary early gastric cancer (SEGC) and 26 MEGC patients who underwent surgical resection were retrospectively reviewed. The clinicopathological features and predictive factors for MEGC patients were evaluated. Also, we analyzed risk factors for LNM and compared survival difference between SEGC and MEGC patients. The frequency of multiple synchronous lesions was 7.1% in early gastric cancer (EGC) patients. The main and minor lesions were mostly confined to the same third of the stomach (84.6%, 22/26), and the most common location was the lower third of the stomach. With regard to the number of coexisting lesions, most of the patients had two lesions and more than three lesions were not common. Tumor size≤2cm (OR:2.684, 95%CI:1.131-6.368, P<0.05) and the presence of atrophic gastritis (OR:2.418, 95%CI:1.052-5.555, P<0.05) were independent risk factors for synchronous MEGC. There was no significant statistical difference between SEGC and MEGC for LNM (17.5% vs 23.1%, P=0.311). The number of coexisting lesions was not associated with the risk of LNM in EGC. In addition, the survival outcome of MEGC patients was similar to that of SEGC (5-year RFS rate, 96.0% vs 93.7%, P=0.329;5-year OS rate, 96.0% vs 88.3%, P=0.479). Meticulous endoscopic examination at the initial diagnosis of MEGC was very important, especially for those with precancerous lesions such as atrophic gastritis. In terms of treatment methods, endoscopic resection may be equally suitable for synchronous MEGC if the lesions fulfilled its indication criteria.

A case of multiple early gastric cancers with variant differentiation including gastric adenocarcinoma of fundic gland type

A case of multiple early gastric cancers with variant differentiation including gastric adenocarcinoma of fundic gland type

Tu1198 CLINICAL ANALYSIS OF ESD FOR THE SYNCHRONOUS MULTIPLE PRIMARY EARLY CANCERS IN ESOPHAGUS AND STOMACH

Objective: With the improvement of endoscopic diagnosis and treatment, the discovery rate of the synchronous multiple primary early cancers in esophagus and stomach is gradually increased, while the traditional surgery bringing serious damages. Endoscopic submucosa dissection (ESD) has become the first treatment option of early cancer or precancerous lesions in the digestive tract partly. This study intends to explore the feasibility, safety and effectiveness of ESD in the treatment of the synchronous multiple early gastric cancer or precancerous lesions in esophageal and stomach. From January 2008 to December 2016, data of 12 patients with early esophageal cancer and early gastric cancer treated by ESD in Endoscopy Center of Zhongshan Hospital, Fudan University were reviewed. We analyzed the patient's history, the size of esophageal and gastric lesions, pathological results, the results of complete or curative resection and so on. Among the 12 patients here described, all diagnosed with synchronous multiple primary early cancers in esophagus and stomach. There were 9 male cases. The mean age was (67 ± 10.6.) years. Mean size was (2.2 ± 1.1) cm in esophageal when 3 lesions located in the upper esophagus, 8 in the middle ， and 1 in the lower. The average size of gastric lesions was (2.1 ± 1.3) cm with 5 lesions in the antrum, 2 in the gastric angle and 5 in cardia. Lesions were removed by ESD in 10 cases at the same time and were removed by stage in 2 case. The complete resection rate was 100% (10/10). Postoperative pathological results showed that there were esophageal precancerous lesions with gastric precancerous lesions in 4 cases, esophageal precancerous lesions with early gastric cancer in 2 cases,early esophageal cancer with gastric precancerous lesions in 3 cases and early esophageal cancer with early gastric cancer in 3 case. 12 patients with 24 lesions were consistent with endoscopic indications, when curative resection rate was 100% (10/10). Postoperative esophageal stricture occurred in 2 cases, which were improved after dilation. Median follow-up time was 30 (8-115)months, when 9 patients survived and 3 patients died. However, the cause of death was not associated with treatment of this disease. Simultaneous endoscopic treatment for esophageal and gastric lesions is rarely reported. There are still many issues that need to be discussed, including whether lesions should be removed at the same time or by stage; which lesion should be removed first; if choosing removed by stage, how long the internal time should be and so on. Howere, ESD is a minimally invasive endoscopic surgery, which can be used as a method of treating synchronous multiple primary early cancers in esophagus and stomach.Tabled 1Clinical data of patients with synchronous multiple primary early cancers in esophagus and stomach treated with ESDNO.sexageesophagus locationsize(cm)pathologic diagnosisinvasionthe basal level and marginesophagus locationsize(cm)pathologic diagnosisinvasionthe basal level and marginpatient simultaneous resectionadditional treatmentcomplicationfollow time(m)prognosis1male65upper0.8low-grade intraepithelial neoplasiam1negativeantrum3high-grade intraepithelial neoplasiam1negativeyesnono84survival2male52middle2high-grade intraepithelial neoplasiam1negativeangle1.5high-grade intraepithelial neoplasiam1negativeyesnono115survival3male60middle1.5high-grade intraepithelial neoplasiam1negativeangle5high-grade intraepithelial neoplasiam1negativenonoesophageal stricture95survival4male84middle3early esophageal cancerm1negativecardia1.5early gastric cancerm2negativeyesnono39die5male78middle3high-grade intraepithelial neoplasiam1negativeantrum1.5high-grade intraepithelial neoplasiam1negativeyesnono27die6male68upper4high-grade intraepithelial neoplasiam1negativecardia1.5early gastric cancerm3negativenonoesophageal stricture30survival7female71upper1early esophageal cancersm1negativecardia1.5early gastric cancerm3negativeyesnono35survival8male84middle3high-grade intraepithelial neoplasiam1negativeantrum1early gastric cancerm3negativeyesnono30survival9female58middle1.4early esophageal cancerm3negativecardia1.5high-grade intraepithelial neoplasiam1negativeyesnono25survival10male59lower0.8early esophageal cancerm2negativeantrum0.6high-grade intraepithelial neoplasiam1negativeyesnono18survival11male57middle3early esophageal cancersm1negativecardia3high-grade intraepithelial neoplasiam1negativeyesnono10die12female68middle2.5early esophageal cancerm3negativeantrum4early gastric cancersm1negativeyesnono8survival Open table in a new tab

Clinical Analysis of Endoscopic Submucosal Dissection for the Synchronous Multiple Primary Early Cancers in Esophagus and Stomach: 12 Cases Report.

With the improvement of endoscopic diagnosis, the discovery rate of the synchronous multiple primary early cancers in esophagus and stomach is gradually increased, while the traditional surgery bringing serious damages. Endoscopic submucosal dissection (ESD) has become the first treatment option of early cancer in the digestive tract partly. This study intends to explore the feasibility, safety, and effectiveness of ESD in the treatment of the synchronous multiple early gastric cancer or precancerous lesions in the esophagus and stomach. From January 2008 to December 2016, data of 12 patients with early esophageal cancer and early gastric cancer treated by ESD in the Endoscopy Center of Zhongshan Hospital, Fudan University were reviewed. We analyzed the patient's history, the size of esophageal and gastric lesions, pathological results, the results of complete or curative resection, and so on. Among the 12 patients described in this study, all were diagnosed with synchronous multiple primary early cancers in the esophagus and stomach. Lesions were removed by ESD in 10 cases at the same time and were removed by stage in 2 cases. The complete resection rate was 100% (24/24), and the curative resection rate was 100% (24/24). Postoperative esophageal stricture occurred in 2 cases, which improved after dilation. Median follow-up time was 30 (8-115) months, when 9 patients survived and 3 patients died. However, the cause of death was not associated with treatment of this disease. ESD is a minimally invasive endoscopic surgery, which can be used as a method of treating synchronous multiple primary early cancers in the esophagus and stomach.

Clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancer and gastric high grade intraepithelial neoplasia

Objective To investigate the clinicopathologic characteristics and relevance of main and minor lesions of synchronous multiple early gastric cancers (SMEGC) and gastric high grade intraepithelial neoplasia (GHGIN). Methods Thirty-two patients with SMEGC or/and GHGIN who were diagnosed and treated with endoscopic submucosal dissection in Nanjing Drum Tower Hospital from July 2012 to September 2016 were enrolled in this study. Their clinicopathologic characteristics were summed up, and the correlation between main and minor lesions on the size, location, endoscopic classification, pathologic type, invasion depth and vascular invasion were analyzed. Results Among the 32 patients, with mean age of 66.19±7.46 years, 90.62%(29/32) were male, 17 cases (53.3%) had family history of gastric cancer, 25 (78.13%) had smoking history, and 22 (68.75%) were alcohol users. There were 30 cases (93.75%) and 31 cases (96.88%) with mucosal atrophy and intestinal metaplasia, respectively. The size of main and minor lesions showed a positive correlation (r=0.4167, P=0.018). The endoscopic classification of major and minor lesions had no statistical significant consistency (P=0.314), but the pathologic type and invasion depth between major and minor lesions demonstrated a moderate significant positive correlation (P<0.05). The comparison of location between the main and minor lesions did not show correlation. However, it showed a significant correlation between major lesion which on the upper 1/3 of stomach and minor lesion on the lower 1/3 of stomach (r=0.463, P=0.003). Further more, when the main lesion was at posterior gastric wall, the minor lesions on lesser curvature were increased, which showed a positive correlation(r=0.417, P=0.009). Conclusion Old-age male with long-term smoking and alcohol history whose lesions combined with surrounding mucosa merger atrophy and intestinal metaplasia are considered as a high risk group in patients with SMEGC or/and GHGIN. Therefore, clinicians must keep high vigilant and make carefully observations on this group of patients during endoscopic examination, and consider the correlation between main and minor lesions to avoid misdiagnosis. Key words: Stomach neoplasms, multiple, synchronization; Early diagnosis; High grade intraepithelial neoplasia; Clinicopathologic characteristics

Simultaneous endoscopic submucosal dissection for multiple early gastric cancers in a low volume center.

The aim of the study is to evaluate the safety and efficacy of simultaneous endoscopic submucosal dissection (ESD) for multiple early gastric cancers.A total of 70 solitary early gastric cancers from 70 patients and 20 multiple early gastric cancers from 10 patients were included in this retrospective study. The curative resection rate, en bloc resection rate, procedure-related complications, and local recurrence were compared between the 2 groups.There was no statistical difference in the rate of complete resection, en bloc resection, and curative resection between the 2 groups (P > .05). No significant difference was found with respect to the occurrence of postoperative bleeding (P > .05). Procedure time was significantly longer in the simultaneous group than that in the single group (87.6 ± 25.1 min vs 54.6 ± 22.0 min, P = .004). The overall incidence of synchronous early gastric cancer was 7.5%.Simultaneous ESD for multiple early gastric cancers is a safe and feasible choice in low-volume hospital. The entire stomach should be examined meticulously during and after ESD. Larger randomized studies are needed to validate our results.

Predictive risk factors associated with synchronous multiple early gastric cancer.

The aim of this study was to elucidate the predictive risk factors of synchronous multiple early gastric cancer regardless of the treatment modality.Patients who underwent early gastric cancer treatment between July 2005 and June 2015 were retrospectively reviewed. In total, 1529 patients who were treated for early gastric cancer were included. We analyzed the patient's data to find predictive factors of synchronous multiple early gastric cancer compared to solitary early gastric cancer. Further analysis was performed to verify the difference between endoscopic and surgical treatment groups.Among the 1529 patients, synchronous multiple early gastric cancer was diagnosed in 68 (4.4%) patients. Significant differences in sex (P = .004), gross appearance (P = .038), depth of invasion (P = .007), and lymphovascular invasion (P = .039) were found between patients with solitary early gastric cancer and synchronous multiple early gastric cancer by univariate analysis. In multivariate analysis, male sex (odds ratio, 2.475; P = .011) and submucosal invasion (odds ratio, 1.850; P = .033) were independent predictive risk factors of synchronous multiple early gastric cancer. In addition, in multivariate analysis, significant differences in age, tumor size, longitudinal location, depth of invasion, and histology were found between patients groups depending on the mode of treatment.Male sex and submucosal invasion were predictive risk factors of synchronous multiple early gastric cancer. Patients with these factors should undergo more meticulous endoscopic surveillance.

Multiple Primary Malignancies in Patients with Multiple Early Gastric Cancer.

PurposeThis study aimed to investigate the correlation between multiple early gastric cancer (MEGC) and multiple primary malignancies during the follow-up of patients with gastrectomy.Materials and MethodsThe number of primary tumors detected in other organs after gastrectomy for early gastric cancer (EGC) has been increasing because of improved survival and surveillance programs. A total of 3,129 patients underwent radical gastrectomy for treatment of EGC at Samsung Medical Center from January 2000 to December 2005. Of these, 3,057 patients were selected and their medical records were retrospectively analyzed.ResultsAmong the 3,057 patients, 148 (4.8%) had MEGC, 84.5% were male, 57.4% were over 60 years old, 42.6% had a macroscopic type EGC IIb main lesion, and 68.9% had well-differentiated tumors with a significantly high incidence of MEGC. There were no differences between patients with solitary early gastric cancer (SEGC) and those with MEGC with regard to overall survival or recurrence-free survival, but MEGC was an independent risk factor for metachronous primary malignancies in other organs (P=0.004, hazard ratio [HR]=2.444).ConclusionsMEGC is not a risk factor for poor prognosis after curative gastrectomy, but it is a risk factor for metachronous primary malignancies in other organs during postoperative follow-up; therefore, careful surveillance is needed.

A Case of Multiple Early Gastric Cancer Associated with Diffuse Submucosal Heterotopic Gastric Glands

A Case of Multiple Early Gastric Cancer Associated with Diffuse Submucosal Heterotopic Gastric Glands

A case of juvenile polyposis of the stomach with multiple early gastric cancers.

The present study described the case of a 24-year-old man who was diagnosed with multiple gastric hyperplastic polyps in 2004. Repeated Helicobacter pylori tests were negative, and colonoscopy revealed no specific findings. The patient started taking a proton-pump inhibitor and iron supplements as a result of anemia caused from the occasional bleeding from the polyps. The number and size of the polyps had increased over time. Endoscopic mucosal resection was occasionally performed when bleeding occurred from large polyps. Finally, histological examination revealed that the surface of the polyp had been replaced with well-differentiated adenocarcinoma in 2014. Laparoscopy-assisted total gastrectomy with Roux-en-Y esophagojejunostomy was performed in 2014. The final diagnosis was juvenile polyposis of the stomach with multiple early gastric cancers. Juvenile polyposis of the stomach is a rare disease, and its malignant potential has been reported previously. The present case highlighted the importance of not delaying surgical intervention in cases of juvenile polyposis of the stomach, since it is associated with a high occurrence of gastric cancer.

Ball valve syndromeを来した多発胃癌の1例

A 73-year-old man was referred to our department because of recurrent epigastralgia and nausea. Esophagogastroduodeno- scopy revealed a pedunculated tumor in the greater curvature of the middle body and drawn folds from the gastric body into the pyloric side. After pushing the scope, the protruding tumor was shifted aside and a good view was obtained. Another pedunculated tumor was evident in the greater curvature of the gastric angle. Computed tomography and gastrography with a barium meal revealed a tumor prolapsing in the duodenum. A diagnosis of multiple early gastric cancer with ball valve syndrome was made. Endoscopic submucosal dissection was performed. Histopathological examination revealed a poorly differentiated adenocarcinoma with an invasion depth of submucosa and lymph vessel permeation was positive. Therefore, the patient underwent a total gastrectomy. He is being followed up regularly.

Clinicopathologic Similarities of the Main and Minor Lesions of Synchronous Multiple Early Gastric Cancer.

The detection rate of early gastric cancer (EGC) is increasing due to improvements in diagnostic methods, but synchronous multiple EGC (SMEGC) remains a major problem. Therefore, we investigated the characteristics of and the correlation between the main and minor lesions of SMEGC. We retrospectively reviewed the medical records of patients with EGC between April 2008 and May 2013. The main lesion was defined as the one with the greatest invasion depth. If lesions had the same invasion depth, the tumor diameter was used to define the main lesion. Of 963 patients who had treatment for EGC, 37 patients with SMEGC were analyzed. The main and minor lesions showed a significant positive correlation of size (r = 0.533, P = 0.001). The main and minor lesions of SMEGC showed the same vertical and horizontal locations at 70.3% and 64.9%, respectively (P = 0.002 and P = 0.002). Macroscopic types were identical in 67.6% (P < 0.001), and 32.4% had identical macroscopic type and location. The main and minor lesions had identical characteristics of invasion depth, presence of lymphovascular invasion (LVI), and differentiation in 78.4%, 83.8%, and 83.8%, respectively. Differentiation, LVI, and invasion depth (microscopic characteristics) were simultaneously the same in 62.2%. The location, macroscopic type, and 3 microscopic characteristics were matched in 27%. The main and minor lesions of SMEGC have similar clinicopathologic characteristics. Therefore, the possibility of SMEGC should not be neglected in cases of EGC, considering an understanding of the characteristics and association of lesions.

Synchronous multiple early gastric cancer diagnosed before treatment ; report of two cases

Recently, synchronous multiple early gastric cancers are being increasingly reported due to the aging of society and development of high-performance endoscopy techniques. We present two cases of synchronous multiple early gastric cancers in which the diagnosis was made before the treatment. In Case 1, three pedunculated lesions measuring approximately 10 mm in diameter and one depressed lesion measuring 20 mm in diameter were detected endoscopically in the gastric antrum, and examination of biopsy specimens revealed the diagnosis of cancer for all the lesions. Laparoscopic subtotal gastrectomy was performed, and histology of the resected tissue revealed intramucosal well-differentiated tubular adenocarcinoma in the three pedunculated lesions and intramucosal poorly differentiated adenocarcinoma in the depressed lesion. In Case 2, two depressed lesions measuring approximately 10 mm in diameter and one pedunculated lesion measuring 3 mm in diameter detected in the gastric body were treated by endoscopic submucosal resection. All the resected lesions were diagnosed histopathologically as intramucosal well-differentiated tubular adenocarcinomas. Histopathological examination revealed evidence of atrophic gastritis with intestinal metaplasia due to H. pylori infection in the background gastric mucosa in both the cases, and the mucin expression phenotype of the gastric cancer was the gastric phenotype in the three pedunculated lesions of Case 1 and the intestinal phenotype in all the three lesions in Case 2. We suggest that the possible presence of synchronous multiple cancerous lesions, e.g., well-differentiated adenocarcinoma located in the atropic gastric mucosa, should be investigated endoscopically in patients diagnosed as having early gastric cancer.

CD44 variant 9 expression in primary early gastric cancer as a predictive marker for recurrence

Background:Multiple early gastric cancers (EGCs) may develop in 6–14% of patients even after achieving curative endoscopic submucosal dissection (ESD); however, a useful biomarker for predicting recurrence is not available. The present study investigated whether the expression of CD44 variant 9 (CD44v9), a functional cancer stem cell marker, in the primary gastric cancer tissue represents an indicator of recurrence.Methods:Eighty-eight patients who underwent ESD for EGC from 2008 to 2010 were enrolled and monitored for recurrence for 3 years. The expression levels of CD44v9 in the tissue of initial EGCs were evaluated by immunohistochemistry, and the recurrence rate was compared between CD44v9-positive and CD44v9-negative groups. The mucin phenotype and expression of microRNA-21 (miR-21) and programmed cell death protein 4 (PDCD4) were also analysed.Results:The recurrence rate of EGC was significantly higher in the CD44v9-positive group than in the CD44v9-negative group (hazard ratio (HR), 21.8; 95% confidence interval (CI), 5.71–83.1). However, mucin phenotypes and the expression of miR-21 and PDCD4 did not predict recurrence after ESD. Meanwhile, grade of gastric atrophy was also identified as a significant marker of multiple recurrence (HR, 4.95; 95% CI, 1.30–18.8).Conclusion:CD44 variant 9 expression represents a potential predictive marker for recurrence in EGC.