Synchronous Gastric Carcinoma Research Articles

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.

Experience of synchronous thoracic and gastric carcinoma resection: a case report

Experience of synchronous thoracic and gastric carcinoma resection: a case report

Tu1505 THE PREVALENCE OF COLONIC POLYPS AND COLORECTAL CANCER IN PATIENTS WITH GASTRIC NEOPLASM: A SYSTEMATIC REVIEW AND META-ANALYSIS

Gastric adenomas are neoplastic with similar microscopic findings to those seen in colonic adenomas. Around 8-59% of gastric adenomas are associated with synchronous gastric carcinoma and hence repeat upper endoscopic surveillance after one year is usually recommended. On the other hand, the data has been scarce and inconsistent with regards to their association with colonic polyps and colorectal cancer. We aimed to analyze the previously published literature evaluating the association between gastric neoplasm and colonic polyps and colorectal cancer. We conducted a systematic literature search in PubMed, MEDLINE, EMBASE, and Cochrane databases from inception through November 2019 to identify studies evaluating the association between gastric adenomas or gastric neoplasms and colonic polyps, advanced adenomas, and colorectal cancer. Gastric neoplasm was universally defined in these studies as either malignancy or adenoma. Studies were examined, and relevant data was extracted and analyzed using Comprehensive Meta-Analysis (CMA), version 3 software. A random-effect meta-analysis approach was used to pool the data and an odds ratio (OR) was calculated for the overall effect estimate. A total of 134,317 patients from seven studies were identified and included in our analysis. The pooled OR for colonic polyps among patients with gastric neoplasm was 1.958 (95% CI:1.511-2.538; p=0.0001) compared to controls with modest heterogeneity (I2 =21.025%). (Fig 1a) Similarly, the pooled OR for advanced colonic adenomas in patients with gastric neoplasm was 2.129 (95% CI: 1.582–2.866; p=0.0001) compared to controls. (Fig 1b)Individuals with gastric neoplasm had an OR of 4.71 (95% CI: 1.296–17.139; p=0.019) for having synchronous colonic adenocarcinoma compared to controls. (Fig 1c)A subgroup analysis including only patients with gastric adenoma found an OR of 1.79 (95% CI: 1.341-2.403; P=0.0001) for having associated colonic polyps compared to controls. (Fig 2) No publication bias was found using Egger’s regression intercept. Our study findings indicate that the prevalence of colorectal polyps, advanced adenomas, and adenocarcinoma is significantly higher in patients with gastric adenomas and/or gastric malignancy compared to the general population. As such, screening colonoscopy may be justified in these patients following the diagnosis of gastric neoplasm for early detection and timely management of colonic neoplasia, particularly for patients over the age of 50 years.Fig 2Forrest plot, the pooled odds ratio evaluating the association between gastric adenoma and colonic polyps.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Clonal Structures of Regionally Synchronous Gastric Adenomas and Carcinomas.

Purpose: Gastric adenoma (GA) is a premalignant lesion that precedes intestinal-type gastric carcinoma (GC). However, genetic progression mechanisms from GA to GC have not been clarified.Experimental Design: We performed whole-exome sequencing-based mutational analyses for 15 synchronous pairs of attached GAs and GCs.Results: There was no significant difference in the number of driver mutations or copy-number alterations between GAs and GCs. Well-known mutations of TP53, APC, RNF43, and RPL22 were recurrently detected in synchronous GA/GC pairs. In addition, we discovered novel KDM6A, PREX2, FAT1, KMT2C, GLI3, and RPL22 mutations and hypermutation in GAs, but did not identify recurrent drivers for GA-to-GC progression. Clonal structure analyses revealed that most GA/GC pairs exhibit parallel evolution with early divergence rather than stepwise evolution during GA-to-GC progression. Of note, three cases were identified as clonally nonrelated GA/GC pairs despite the lack of histologic differences. We found differences in dominant mutational signatures 1, 6, 15, and 17 in GA/GC trunks, GA branches, and GC branches. Compared with our previous work on synchronous colon adenoma/carcinoma genome structures, where most drivers were in the trunk with parallel evolution, synchronous GA/GC genomes showed a different model of parallel evolution, with many drivers in the branches.Conclusions: The preferred sequence of mutational events during GA-to-GC progression might be more context-dependent than colon adenoma progression. Our results show that nonclonal synchronous GA/GC is common and that GA genomes have already acquired distinct genomic alterations, suggesting caution in the diagnosis of synchronous GA and GC, especially in residual or recurrent cases. Clin Cancer Res; 24(19); 4715-25. ©2018 AACR.

Metastatic Invasive Lobular Breast Carcinoma Mimicking Synchronous Breast and Gastric Cancers

Metastatic lobular carcinoma to stomach is seen as small round cells in linear cords within the normal tissue and it is not easily differentiated from signet cell adenocarcinoma of the stomach. Differentiating synchronous primary gastric carcinoma from metastatic involvement is vital in accurately planning treatment. Herein, we report a case of gastric metastatic invasive lobular breast carcinoma initially misdiagnosed as synchronous gastric and breast carcinoma and discuss the diagnostic and therapeutic challenges.

Synchronous gastric and colon carcinomas: A case report and review of literature

Synchronous gastric and colon carcinomas: A case report and review of literature

Surgical treatment of synchronous gastric and esophageal carcinoma: case report and review of literature.

A 65-year-old man was admitted to our hospital because of advanced esophageal squamous cell carcinoma located on the left posterior wall of the lower thoracic esophagus and gastric adenocarcinoma in the antrum. Esophagectomy and distal gastrectomy with two-field lymph node dissection (mediastinum and abdomen) were performed via a left-sided abdominothoracic incision. The remnant gastric was pulled up successfully with the blood supply maintained by the left gastric vessel. He was discharged on the 13th postoperative day without any complications.

PWE-222 Audit of upper GI cancer diagnosis by endoscopy: are diagnoses being missed?

IntroductionGastric and oesophageal cancers have a high mortality rate, particularly if diagnosed at a late stage. We aimed to determine whether Upper Gastrointestinal (UGI) cancers are being missed either endoscopically...

EBV infection and mismatch repair deficiency mediated by loss of hMLH1 expression contribute independently to the development of multiple synchronous gastric carcinomas

To explore the possible association between EBV, microsatellite instability (MSI), and alterations of hMLH1 protein, 282 tumors from 141 patients with multiple synchronous gastric carcinomas (MSGC) were studied. In situ hybridization for EBV-encoded small RNA and hMLH1 immunohistochemistry were performed in tissue microarrays. In 19 MSGC cases with altered hMLH1 expression, methylation analyses by MethyLight and MSI tests were performed. Loss of hMLH1 was found in 19 of 141 MSGC patients (13.5%) and 26 of 282 MSGC tumors (9.2%). hMLH1 loss was associated with differentiated histology (P = 0.03). Out of the 38 tumors from 19 hMLH1-negative MSGCs, 12 tumors from six cases (31.6%) showed concurrent methylation of hMLH1 and MSI-high in both multiple tumors. EBV was found in 31 of 141 MSGC patients (21.9%) and 49 of 282 MSGC tumors (17.4%) and was significantly associated with undifferentiated histology and a location within the upper third of the stomach (P < 0.002). EBV was not observed in any of the tumors that had a loss of hMLH1 expression. Considering that EBV-associated GCs show global CpG island methylation, our findings suggest that EBV infection allows the gastric mucosa to escape from aberrant methylation of hMLH1 and induces a malignant pathway independent of MSI.

Synchronous Hepatocellular Carcinoma and Gastric Carcinoma—A Case Report with Review of the Literature

Synchronous Hepatocellular Carcinoma and Gastric Carcinoma—A Case Report with Review of the Literature

A case of Cowden's syndrome presenting with gastric carcinomas and gastrointestinal polyposis

A 73-year-old white man was referred to a cancer genetics clinic for evaluation of a approximately 20-year history of mixed upper and lower gastrointestinal polyposis, including hyperplastic, inflammatory and adenomatous polyps, colonic ganglioneuromas, and associated diffuse, esophageal glycogenic acanthosis. Two synchronous gastric carcinomas had been identified before referral and the patient had undergone a total gastrectomy, omentectomy and cholecystectomy. Multiple hyperplastic polyps and small, sessile polyps were also observed in the gastrectomy specimen. History and physical examination, upper and lower gastrointestinal endoscopy and biopsy, genetic testing, molecular pathology investigations (immunohistochemistry), thyroid ultrasonography, fine-needle aspiration of a thyroid nodule. Cowden's syndrome. Genetic counseling, thyroidectomy, vitamin B(12) supplementation, continued endoscopic surveillance and genetic testing of at-risk family members.

An unusual case of synchronous lymphoma and adenocarcinoma occurring as a collision tumour in the stomach – a case report

Summary The occurrence of malignant gastric lymphoma and adenocarcinoma in the same patient is very rare. Here we report a case of synchronous gastric carcinoma and gastric lymphoma with a follicular growth pattern associated in a 73-year-old man. Preliminary diagnosis gastric tumour was suggested so laparotomy was performed for the purpose of treatment resection of the stomach. In the operation field, there was a main lesion spreading through the whole of the stomach and additional multiple lymph node enlargements at the hepato-duodenal, retro-pancreatic and the para-aortic lymph nodes. A short-term intraoperative examination of one of the metastatic lymph nodes showed lymphoma of the stomach. Palliative total gastrectomy Roux-en-Y was performed. Finally the pathology of the specimen revealed two different collided tumours: adenocarcinoma solidum and non-Hodgkin's lymphoma malignum with follicular growth pattern. Following surgery and chemotherapy, the patient is now in a disease progress state.

Metastatic renal cell carcinoma masquerading as a primary gastric carcinoma associated with synchronous early gastric carcinoma

Metastatic renal cell carcinoma masquerading as a primary gastric carcinoma associated with synchronous early gastric carcinoma

Synchronous Early Gastric Cancer Resembling Submucosal Tumor at the Fundus

Concern about detecting gastric carcinoma in its early stages has increased the incidence of detecting multiple synchronous gastric carcinomas. Although gastric carcinomas may present with various gross features, those showing the features of submucosal tumor (SMT) are rare. We report on a case of synchronous gastric carcinomas comprising one lesion with typical features of superficial early gastric carcinoma and the other with atypical features that mimicked SMT. Even though synchronous gastric carcinoma is rare, it may be worthwhile to make a pathological diagnosis of coexisting SMT using endoscopic-ultrasound-guided fine-needle aspiration or endoscopic mucosal resection.

Surgical treatment and clinical course of patients with hypopharyngeal carcinoma

In the period between 1 January 1978 and 1 January 2004, 85 patients with hypopharyngeal squamocellular carcinoma were admitted at the Department of Esophagogastric Surgery in Belgrade. Among them, only 46 patients (54.1%) had radical surgical en-block resection and functional neck dissection, and they were included into an historical cohort study. In 40 patients a pharyngolaryngoesophagectomy was performed using for reconstruction, stomach tissue in 29 and colon tissue in 11 patients. Since 1996, in six patients with localized hypopharyngeal carcinoma pharyngolaryngectomy was performed with resection of cervical esophagus and free jejunal graft interposition. The overall incidence of morbidity was 50.0% and the overall mortality rate was 13.0% (6 patients). Mean hospital stay was 35 days (range, 18-78 days). The median survival of patients was 26 months, and overall 5-year survival rate was 26.5%. At present, surgery seems to be the appropriate therapeutic choice for patients with advanced hypopharyngeal carcinoma, providing a definitive palliation of dysphagia and relatively good long-term survival. At our Institution, after pharyngolaryngoesophagectomy, reconstructive method of choice is gastric 'pull-up', and the colon is used only when stomach tissue is not available, that is, previous gastric resections, inappropriate blood supply, synchronous gastric carcinoma and so on. Recently, pharyngolaryngectomy and free jejunal transfer has become the standard technique in patients with small carcinomas (up to 3 cm) confined to the hypopharynx in the absence of synchronous esophageal and/or gastric carcinoma.

Allelic loss of 14q32 in the pathogenesis of gastrointestinal and ampullary malignancies: mapping of the target region to a 17�cM interval

The genetic basis for gastrointestinal and ampullary carcinomas remains uncertain. This study was performed to pinpoint novel chromosomal region involved in the tumorigenesis of gastrointestinal tract. We screened the allelic status on 16 chromosomal arms in a patient with synchronous ampullary carcinoma and gastric cancer, but who had no family history of familial cancer syndrome. The significance of the shared 14q deletion was examined on clinical cohorts of sporadic gastric (n=12) and ampullary (n=10) carcinoma, respectively. Then, high-density allelotype mapping was performed on 14q32 by using 23 microsatellite markers for the synchronous tumors. The synchronous gastric and ampullary carcinomas had no frameshift mutations in the APC, MSH2, MSH3, and MSH6 genes. Among the microsatellite markers screened, only D14S267 showed identical loss in the synchronous tumors. The same allelic loss was also detected in one of ampullary carcinomas (10%) and two of gastric cancers (16.7%). Fine mapping of 14q determined a minimally deleted region between D14S65 and D14S1010 (17 centiMorgans) for the synchronous tumors. This study illustrates a paradigm using molecular genetic approach in identifying chromosome 14q32 that may harbor a tumor suppressor gene involved in the pathogenesis of a subset of gastrointestinal and ampullary malignancies.

Advanced Gastric Carcinoma With a Complete Intestinal Metaplasia Phenotype Associated With Early Intestinal-Type Carcinoma

An unusual case of synchronous gastric carcinomas occurred in a 28-year-old man with a family history of gastric disease. Two tumor foci were identified: a well-differentiated advanced carcinoma with the phenotypic properties of complete intestinal metaplasia and an early intestinal-type carcinoma. Histochemical and immunohistochemical stains to demonstrate complete intestinal metaplasia, ie, Alcian blue pH 2.5/periodic acid-Schiff, high iron diamine/Alcian blue pH 2.5, CD10, and MUC2, were all positive in the advanced adenocarcinoma. Of all markers used, only high iron diamine/Alcian blue pH 2.5 and Alcian blue pH 0.5 were positive in the early carcinoma. In these cases, mistakes frequently are made during examination of endoscopic biopsies. Fortunately, the advanced adenocarcinoma was low grade (the patient has shown no signs of disease at 6 years postsurgery). Histopathologic, histochemical, and immunohistochemical findings suggest that an extensive substrate of complete intestinal metaplasia (corpus) and of complete and incomplete intestinal metaplasia (antrum) can be associated with two independent tumors with different phenotypes.

Epstein-Barr virus and microsatellite instability in gastric carcinogenesis.

Little information is available concerning the relationship between transforming viruses and microsatellite instability (MSI). We evaluated Epstein-Barr virus (EBV) using in situ hybridization for EBV-encoded small RNAs and MSI using the polymerase chain reaction in surgically resected gastric cancer. The study subjects included 298 consecutive cases of solitary gastric carcinoma, 63 gastric carcinomas in young patients (</=30 years old), 64 cases of gastric cancer coexisting with gastric adenoma in a single lesion, 26 cases of gastric remnant cancer, and 98 carcinomas from 47 patients with synchronous multiple gastric carcinomas. There was no overlapping case among these subsets of gastric cancer. None of these 549 gastric carcinomas demonstrated both EBV positivity and MSI positivity. Furthermore, the EBV-positive and the MSI-positive cases showed a mutually negative association in all subsets of gastric cancer. 5.7% of consecutive solitary gastric carcinomas were EBV positive, and 9.7% were MSI positive. EBV was positive in 1.6% of gastric cancers coexisting with gastric adenoma, 12.7% of younger patients, 28.6% of gastric remnant cancer with previous gastrectomy for benign disease, and 14.5% of synchronous cancers without adenoma. MSI was found in 1.6% of younger patients, 18.8% of gastric cancers coexisting with gastric adenoma, 25% of gastric remnant cancer with previous gastrectomy for gastric cancer, and in 53.3% of synchronous gastric carcinomas having gastric adenoma remote from the cancer. In conclusion, the carcinogenic roles of EBV and MSI may be different in terms of each subset of gastric cancer. EBV and MSI may contribute to functionally equivalent pathways in gastric carcinogenesis.

Microsatellite instability in synchronous gastric carcinomas.

Synchronous gastric carcinomas are found in 4% to 10% of all gastric carcinomas, and the tumor multiplicity is believed to be related to genetic predisposition. To investigate the role of mismatch repair error in synchronous gastric carcinomas, we analyzed the microsatellite instability (MSI) status of 101 cancers from 48 gastrectomy specimens and compared them with 149 solitary gastric carcinomas. Multiple synchronous gastric carcinomas are characterized by slightly older age, predominance in males, early stage and lower lymph node metastasis. Among the 48 cases, 8 (18 lesions) were associated with a gastric adenoma (type I) and 40 (83 lesions) were not associated with a gastric adenoma (type II). The MSI+ rate was 50% in the type I and 8.4% in the type II synchronous gastric carcinomas (p < 0.001), while that of solitary gastric carcinomas was 9.4%. In addition, the frameshift mutation rates of the TGF-betaRII, BAX and hMSH3 genes in the type I synchronous carcinomas were higher than those in the type II synchronous carcinomas. These findings indicate that a defect in the mismatch repair system might play a role in the carcinogenesis of a minor subset of multiple gastric carcinomas associated with adenomas.

Ruptured retroperitoneal mucinous cystadenocarcinoma with synchronous gastric carcinoma and a long postoperative survival: Case report

Ruptured retroperitoneal mucinous cystadenocarcinoma with synchronous gastric carcinoma and a long postoperative survival: Case report