Comparative study of clinical-morphological profiles of different types of gastric carcinoma.

AIM: Gastric carcinoma shows considerable variation in the histological pattern and degree of differentiation. The aim of the study was to assess especially the morphological differences between gastric carcinomas revealing one morphological feature and those including two morphological features. MATERIALS AND METHODS: Two groups of patients were selected: Group 1, including 43 patients with tumors revealing only one architectural pattern, and Group 2, including 16 patients with two architectural patterns within the tumor. In addition to gender and age, the main morphological parameters were: lesion location and macroscopic appearance on the surgical excision sample and microscopic appearance of the surgical excision sample, assessed for architectural pattern, secretory properties and prognosis based on histological features, degree of tumor extension and the degree of tumor aggressiveness, using a wide range of histological and immunohistochemical stainings. All data were compared between the two groups using statistical tests. RESULTS AND DISCUSSION: Significant differences were observed between the values and distributions of morphological parameters in the two groups and were discussed comparatively. CONCLUSIONS: Tumors with two dominant histological aspects present simultaneously are a reality that cannot be argued but whose morphological and biological profile needs to be completed and validated.

The role of endoscopic examination accompanied by histological examination on biopsy samples in the diagnosis of gastric carcinoma.

INTRODUCTION: Endoscopic evaluation is one of the most important explorations in the diagnosis of gastric cancer, increasing its value by adding biopsy sampling and histopathologic examination, especially in early forms of gastric malignant proliferations. The aim of this study was to evaluate some descriptive parameters of macroscopic and microscopic aspects of gastric carcinomas defined with the help of endoscopic investigation and gastric biopsies sampled during endoscopic examination, and their correlation with patient survival. MATERIALS AND METHODS: The study was performed on a group of 119 patients diagnosed with gastric carcinoma. The study material was represented by: tissue fragments obtained by endoscopic biopsy, clinical observation charts, histopathologic diagnosis records, ledgers for records of endoscopic investigation, and endoscopic images recorded for each patient. Biopsies were taken preferentially from areas with the highest risk of malignancy. Tumor fragments were subjected to conventional histological processing techniques (fixation and inclusion in paraffin) and then were stained with HIM. The study included two chapters: the imagistic study and the pathologic study. The parameters assessed were: the site of the lesion within the stomach, the endoscope macroscopic appearance, the microscopic appearance of the endoscope biopsy sample, and the survival, followed up until 48 months. RESULTS: The most frequently observed macroscopic aspect was the fungating one, in more than two thirds of all cases, followed by the infiltrating one, but all with a poor survival - about 25-30% at 24 months. The most frequent location was the antro-pyloric region, with the highest survival rate of 25% at 24 months, followed by the gastric corpus and the lesser curvature. Most of the tumors were restricted to a single segment of the stomach. The most frequent microscopic aspect was the tubular one (75% of all cases) with its poorly differentiated variant (39 of the 91 cases). The 24 months survival was under 50% for all morphological types of carcinoma, with the lowest ones in the tubular and mucinous types (around 25%). The secretory pattern was identified on biopsy samples stained with HE in only 15% of the cases, and did not influence the survival of the patients. CONCLUSIONS: The combined histologic and endoscopic morphologic investigation allowed the shaping of an accurate morphologic and prognostic preoperative profile in gastric carcinomas.

Invasion assessment in gastric carcinoma - imagistic and histopathologic combined study.

INTRODUCTION: Imagistic examinations have an essential role in the assessment of gastric cancer both in earlier and advanced stages. Among these, endoscopic ultrasound (EUS) especially contributes to the diagnosis by direct visualization of the tumor and to the staging and prognosis assessment through the evaluation of the gastric wall and regional lymph nodes. Computer tomography (CT) examination also has an important role, especially in advanced stages, in the assessment of the prognosis, contributing to TNM staging. The aim of this study is a comparative assessment of tumor invasion degree by these two imagistic methods and the correlation of the imagistic diagnosis with histopathologic assessment results on surgical specimens. MATERIALS AND METHODS: The basis of the study was represented by a group of 38 patients with gastric carcinoma investigated both by endoscopic ultrasound and computer tomography from which 15 cases with surgical excision of the tumor followed by microscopic examination were selected. Studied material was represented by: patients' medical charts, registers for ultrasound endoscopy and CT investigation, endoscopic and CT images, surgical excision samples and pathology reports. Tumor fragments were processed by classical histological techniques (fixation and paraffin wax embedding) and staining (HE). RESULTS: Comparing the CT examination with ultrasound endoscopy results showed that CT examination overestimated the invasion grade of the gastric wall (T) but accurately defined the grade of lymph node invasion (N) and metastases (M). Comparing the results of ultrasound endoscopic examination with those from histopathological examination showed that the first method underestimated the grade of invasion of the gastric wall (T) while the latter correctly defined the grade of lymph node invasion (N) and metastases (M). Comparing CT examination results with histopathological ones showed that CT overestimated both the grade of invasion of the gastric wall (T), lymph node invasion (N) and metastases (M). CONCLUSIONS: In the preoperative assessment of the invasion stage of gastric carcinoma (TNM), ultrasound endoscopy is the elective imagistic investigation for predicting the grade of invasion of the gastric wall while CT examination is a more accurate assessment of lymph node extension and metastases, the precise definition of invasion stage being only the result of histopathological examination on surgical specimens.