Derived from Chu PG, Weiss LM. Histopathology 2002, 40:403-439 and other sources
Hepatoid variant has very poor prognosis
Hereditary diffuse gastric carcinoma
Autosomal dominant, 70% penetrance
Carcinomas present at mean age 38
Diagnosis requires either
2 cases in 1st or 2nd degree relatives, with one case <50 years, OR
3 cases in 1st or 2nd degree relatives, any age
Females also at risk for lobular carcinoma of breast
Endoscopy may be too insensitive to be of value
Grading / Staging
WHO gastric adenocarcinoma grading criteria
Well differentiated – well formed glands
In areas may be difficult to distinguish from benign atypia
Moderately differentiated - may be combined with well as low grade
Highly irregular glands, difficult to discern, or
Single cells and clusters
EGJ TNM is staged as esophagus
Tumor center must be within 5 cm of and cross junction
Intramucosal carcinoma is variably defined
and has poor interobserver agreement
A strict definition requires at least focal identification of detached single infiltrating cell(s)
A looser definition requires a cribriform pattern or growth in a pattern incompatible with pre-existing glands
Marked crowding, branching, budding
In either case, there is no invasion beyond the muscularis mucosae
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