A. Scirrhous Carcinoma
B. Peptic Ulcer
C. Atrophic Gastritis
D. Fungating Carcinoma
Ans:A. Scirrhous Carcinoma.
MORPHOLOGY OF GASTRIC CARCINOMA
I. EARLY GASTRIC CARCINOMA :
- Cancer limited to the mucosa and submucosa.
- Grossly, the lesion of EGC may have 3 patterns—polypoid (protruded), superficial and ulcerated .
- Histologically, EGC is a typical glandular adenocarcinoma, usually well-differentiated type.
- Early gastric carcinoma must be distinguished from certain related terms as under:
- Epithelial dysplasia is cellular atypia seen in intestinal metaplasia such as in atrophic gastritis and pernicious anaemia.
- Carcinoma in situ in the stomach is a state of severe cellular atypia or dysplasia, without invasion across the basement membrane of the glands.
II. ADVANCED GASTRIC CARCINOMA.
- When the carcinoma crosses the basement membrane into the muscularis propria or beyond, it is referred to as advanced gastric carcinoma. Advanced gastric carcinoma has following 5 patterns:
i. Ulcerative carcinoma
- The tumour appears as a flat, infiltrating and ulcerative growth with irregular necrotic base and raised margin.
- It is seen more commonly in the region of gastric canal .
- Histologically, ulcerative carcinomas are poorly differentiated adenocarcinomas, which invade deeply into the stomach wall.
ii. Fungating (polypoid) carcinoma .
- The second common pattern is a cauliflower growth projecting into the lumen.
- It is seen more often in the fundus.
- Histologically, fungating or polypoid carcinomas are well-differentiated adenocarcinomas, commonly papillary type.
iii. Scirrhous carcinoma (Linitis plastica).
- In this pattern, the stomach wall is thickened due to extensive desmoplasia giving the appearance as ‘leatherbottle stomach’ or ‘linitis plastica’.
- The involvement may be localised to pyloric antrum, or diffuse affecting whole of the stomach from the cardia to pylorus.
- The lumen of the stomach is reduced. There are no ulcers but rugae are prominent .
- Histologically, it may be an adenocarcinoma or signetring cell carcinoma, extensively infiltrating the stomach wall, but due to marked desmoplasia cancer cells may be difficult to find.
iv. Colloid (Mucoid) carcinoma.
- This pattern is usually seen in the fundus.
- The tumour grows like masses having gelatinous appearance due to secretion of large quantities of mucus.
- Histologically, mucoid carcinoma contains abundant pools of mucin in which are seen a small number of tumour cells, sometimes having signet-ring appearance.
v. Ulcer-cancer .
- Development of cancer in chronic gastric ulcer is a rare occurrence (less than 1%).
- Histologically, ulcer-cancers are adenocarcinomas without any specific features.