Malignant Diseases of the Stomach Advanced Gastric Carcinoma

■ Classification

The morphological forms of advanced gastric carcinoma were classified by Borrmann into four types (Figs. 3.107, 3.108):

- This is a frequently broad-based, polypoid lesion that is virtually indistinguishable from a benign epithelial polyp by its macroscopic features. This type is seen in approximately 30% of cases.

► Type II, polypoid form with ulceration

- The distinguishing endoscopic feature of this carcinoma is its exophytic growth with central ulceration, producing a craterlike appearance. Biopsy specimens should be taken from the margin, as the center is necrotic. This type is also seen in approximately 30% of cases.

► Type III, infiltrating form with ulceration

- Type III is a shallow infiltrating cancer that undermines the mucosa and shows superficial ulceration. This can make it difficult to distinguish from a benign ulcer. It may be poorly demarcated from its surroundings, and the adjacent undermined mucosa frequently appears normal. Biopsy specimens should be taken from the ulcer margin. This type is seen in approximately 10 % of cases and tends to metastasize early, implying a very poor prognosis.

► Type IV, diffusely infiltrating form

- The extent of submucosal infiltration by this tumor cannot be determined by endoscopy. The mucosa is irregular, and the stomach wall is firm, indurated, and nondisten-sible. In some cases the submucosal growth leads to stricture formation. This type, seen in approximately 30 % of cases, tends to metastasize early and is usually very extensive when diagnosed.

Fig. 3.107 Borrmann morphological classification of advanced gastric carcinoma

Fig. 3.107 Borrmann morphological classification of advanced gastric carcinoma

a Polypoid form
b Polypoid form with ulceration
c Infiltrating form with ulceration

d Diffusely infiltrating form

d Diffusely infiltrating form jy . ' ,

Fig. 3.108 Advanced gastric carcinoma a Tumor in the cardia region. Histology: undifferentiated carcinoma

Fig. 3.108 Advanced gastric carcinoma a Tumor in the cardia region. Histology: undifferentiated carcinoma ib»

b Infiltration of surrounding tissues c Polypoid tumor

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