“Crawling-type” adenocarcinoma of the stomach: a distinct entity preceding poorly differentiated adenocarcinoma

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 16; no. 2; pp. 220 - 232
• Main Authors: Okamoto, Naoko, Kawachi, Hiroshi, Yoshida, Tatsuya, Kitagaki, Keisuke, Sekine, Masaki, Kojima, Kazuyuki, Kawano, Tatsuyuki, Eishi, Yoshinobu
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.04.2013; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma - metabolism; Adenocarcinoma - pathology; Adenocarcinoma - physiopathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Cancer Research; CDX2 Transcription Factor; Cell Differentiation; Female; Gastric cancer; Gastric Mucosa - pathology; Gastroenterology; Homeodomain Proteins - analysis; Homeodomain Proteins - metabolism; Humans; Ki-67 Antigen - analysis; Ki-67 Antigen - metabolism; Lymphatic Metastasis - pathology; Male; Medicine; Medicine & Public Health; Microvilli - metabolism; Microvilli - pathology; Middle Aged; Mucins - metabolism; Oncology; Original Article; Phenotype; Stomach Neoplasms - metabolism; Stomach Neoplasms - pathology; Stomach Neoplasms - physiopathology; Stomach Neoplasms - surgery; Surgical Oncology; Tumor Suppressor Protein p53 - analysis; Tumor Suppressor Protein p53 - metabolism; Ki-67; Poorly differentiated adenocarcinoma; Gastric cancer; Irregularly fused glands; Crawling-type adenocarcinoma
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-012-0173-2

Background Gastric “crawling-type” adenocarcinoma (CTAC) is a neoplasm histologically comprising irregularly fused glands with low-grade cellular atypia that tends to spread laterally in the mucosa. It is necessary to elucidate the clinicopathological characteristics of CTAC. Methods We evaluated 25 CTACs–16 intramucosal (M-) and 9 submucosal invasive (SM-) cancers–clinicopathologically and immunohistochemically. Results CTAC was most frequently located in the lesser curvature of the middle-third of the stomach. Macroscopically, 21 lesions were superficial-depressed and 4 were superficial-flat type. Histologically, all CTACs had cystic dilated glands and 16 lesions had focal signet-ring cells. All invasive areas of the SM-CTACs were occupied by poorly differentiated adenocarcinoma with an infiltrative growth pattern and abundant stroma. Fifteen CTACs were surrounded by mucosa with partial or no intestinal metaplasia. In the intramucosal area, 24 lesions were mixed phenotype with mucin and brush border immunoexpression. SM-CTAC was frequent in lesions with an intramucosal poorly differentiated component (PDC) greater than 10 mm in size ( P  = 0.041), and lymph node metastasis (LNM) was frequent in lesions with a PDC greater than 20 mm ( P  = 0.039). The frequency of an expanded pattern (Ki-67-positive cells occupying > 50 % of the mucosa) was higher in SM-CTAC than in M-CTAC ( P  = 0.027). p53 overexpression was not detected in the intramucosal areas of any of the lesions. Conclusion CTAC is a distinct subgroup of gastric adenocarcinoma in the early phase. A larger PDC and a Ki-67 expanded pattern were predictive of submucosal invasion or LNM.