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Growth Patterns of Signet Ring Cell Carcinoma of the Stomach for Endoscopic Resection

 Hyunki Kim  ;  Jie-Hyun Kim  ;  Yong Chan Lee  ;  Hoguen Kim  ;  Young Hoon Youn  ;  Hyojin Park  ;  Seung Ho Choi  ;  Sung Hoon Noh  ;  Takuji Gotoda 
 Gut and Liver, Vol.9(6) : 720-726, 2015 
Journal Title
 Gut and Liver 
Issue Date
Adult ; Carcinoma, Signet Ring Cell/pathology* ; Carcinoma, Signet Ring Cell/surgery* ; Dissection/methods* ; Female ; Gastric Mucosa/pathology ; Gastroscopy* ; Humans ; Intestines/pathology ; Male ; Metaplasia/pathology ; Middle Aged ; Neoplasm Invasiveness ; Retrospective Studies ; Stomach/pathology ; Stomach Neoplasms/pathology* ; Stomach Neoplasms/surgery*
Carcinoma, signet ring cell ; Endoscopy ; Resection ; Stomach neoplasms
BACKGROUND/AIMS: It is difficult to precisely detect the lateral margin during endoscopic submucosal dissection (ESD) for signet ring cell carcinoma (SRC) because SRC often expands to lateral direction through the lamina propria. Thus, the aim of this study was to classify the intramucosal spreading patterns of SRC and to analyze the patients' clinicopathological findings according to the spreading patterns. METHODS: The intramucosal spreading patterns of SRC were classified as expansive or infiltrative types. A total of 100 surgical and 42 ESD specimens were reviewed. RESULTS: In the surgical specimens, the proportions of expansive and infiltrative types were 44% and 56%, respectively. The infiltrative type was more commonly associated with old age, atrophy, and intestinal metaplasia in surrounding mucosa and the absence of Helicobacter pylori compared with the expansive type. In ESD specimens, the proportions of expansive and infiltrative types were each 50%. When lateral margin-positive lesions were compared with -negative lesions, larger size, residual lesion, and the lack of a neutrophil infiltration were more significantly associated with lateral margin-positive lesions. All cases with residual tumors in lateral margin-positive lesions were classified as the infiltrative type. CONCLUSIONS: SRC surrounded with atrophy and/or intestinal metaplasia often spreads subepithelially in the margin. This finding may suggest that a larger safety margin is necessary in this type during ESD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
김지현(Kim, Jie-Hyun) ORCID logo https://orcid.org/0000-0002-9198-3326
김현기(Kim, Hyunki) ORCID logo https://orcid.org/0000-0003-2292-5584
김호근(Kim, Ho Keun)
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
박효진(Park, Hyo Jin) ORCID logo https://orcid.org/0000-0003-4814-8330
윤영훈(Youn, Young Hoon) ORCID logo https://orcid.org/0000-0002-0071-229X
이용찬(Lee, Yong Chan)
최승호(Choi, Seung Ho) ORCID logo https://orcid.org/0000-0002-9872-3594
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