INTRODUCTION: Although signet ring cell carcinoma (SRC) is a poorly differentiated cancer subtype, recent studies suggest that endoscopic resection can be applied in small, mucosal early gastric SRC. However, other studies report frequent positive lines at the lateral resection margin after endoscopic treatment. Subepithelial spread beneath normal mucosa can exist in SRC, and such lesions may be the cause of positive margins after endoscopic resection. Thus, we conducted a retrospective study in order to evaluate the significance of subepithelial spread in early gastric SRC. METHOD: Medical records of early gastric SRC patients who underwent surgery or endoscopic resection from January 2011 to December 2016 at a single tertiary hospital (Daejeon, South Korea) were reviewed to examine subepithelial spread and clinical datum. 2 expert pathologists reviewed all pathologic specimens and only patients showing a pure SRC component were included. RESULTS: 86 patients were initially enrolled and subepithelial spread existed in 62 patients (72.1%). The mean distance of subepithelial spread was 1132.1µm, and maximal the maximal distance was 6000µm. Only discoloration was significantly associated with the presence of a subepithelial spread (p < 0.05, chi-square test and logistic regression test). Distance of subepithelial spread did not correlate with total lesion size. CONCLUSION: Subepithelial spread of early gastric SRC occurs frequently, and can reach up to 6 mm. Lesion discoloration may be associated with the presence of subepithelial spread. Our results suggest that careful decision of margin is needed when performing endoscopic resection of early gastric SRC. .
INTRODUCTION: Although signet ring cell carcinoma (SRC) is a poorly differentiated cancer subtype, recent studies suggest that endoscopic resection can be applied in small, mucosal early gastric SRC. However, other studies report frequent positive lines at the lateral resection margin after endoscopic treatment. Subepithelial spread beneath normal mucosa can exist in SRC, and such lesions may be the cause of positive margins after endoscopic resection. Thus, we conducted a retrospective study in order to evaluate the significance of subepithelial spread in early gastric SRC. METHOD: Medical records of early gastric SRCpatients who underwent surgery or endoscopic resection from January 2011 to December 2016 at a single tertiary hospital (Daejeon, South Korea) were reviewed to examine subepithelial spread and clinical datum. 2 expert pathologists reviewed all pathologic specimens and only patients showing a pure SRC component were included. RESULTS: 86 patients were initially enrolled and subepithelial spread existed in 62 patients (72.1%). The mean distance of subepithelial spread was 1132.1µm, and maximal the maximal distance was 6000µm. Only discoloration was significantly associated with the presence of a subepithelial spread (p < 0.05, chi-square test and logistic regression test). Distance of subepithelial spread did not correlate with total lesion size. CONCLUSION: Subepithelial spread of early gastric SRC occurs frequently, and can reach up to 6 mm. Lesion discoloration may be associated with the presence of subepithelial spread. Our results suggest that careful decision of margin is needed when performing endoscopic resection of early gastric SRC. .
Authors: John G Aversa; Laurence P Diggs; Brendan L Hagerty; Dana A Dominguez; Philip H G Ituarte; Jonathan M Hernandez; Jeremy L Davis; Andrew M Blakely Journal: J Gastrointest Surg Date: 2020-07-23 Impact factor: 3.267