Clinicopathological Study of Minute Gastric Carcinoma in Surgically Resected Multiple Gastric Carcinoma Cases

Hirotaka Nakashima, Ryuji Nagahama, Yasuo Ohkura, Michiyo Owari, Nobuhiro Sakaki, Misao Yoshida


AIM: Therapeutic endoscopy has been widely adopted, and most of intramucosal gastric carcinomas are commonly treated by endoscopic submucosal dissection (ESD). In order to achieve an appropriate endoscopic treatment, this study is designed to reveal multiple and minute gastric carcinomas, which may be overlooked at preoperative endoscopy.

METHODS: We retrospectively examined clinicopathological findings and endoscopic images of 80 carcinoma lesions from 28 multiple gastric carcinoma patients. The entire region of resected stomachs were pathologically examined, after that carcinomas were evaluated clinicopathological findings, i.e., size, histlogical type, depth of invasion, background mucosa, distribution of the carcinomas, and preoperative diagnosis by endoscopy.

Results: The patients with multiple gastric carcinomas were accounted for 26.9% of all surgically treated cases. There were 17 double and 5 triple carcinomas, and 6 quadruple quintuple or sextuple carcinomas. In cases in which the second carcinoma was detected, the probability of a third carcinoma was 39.2%. Lesions after the third carcinoma were likely to be minute gastric carcinoma (less than 5 mm in size) in which preoperative endoscopic detection rate was 25%.

CONCLUSIONS: During endoscopic treatment for gastric carcinoma, it needs to pay attention to the residual multiple or minute gastric carcinoma in the stomach, which may lead to a predisposition for metachronous multiple gastric carcinoma. Careful pretherapeutic examination and follow-up by endoscopy should be performed to achieve an appropreate endoscopic treatment in cases of multiple gastric carcinomas.

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