Intestinal type adenocarcinoma
Reviewers: Elliot Weisenberg, M.D. (see Reviewers page)
Revised: 12 October 2012, last major update August 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.
● Bulky tumors composed of glandular structures
● Mean age 55 years, 2/3 men
● Incidence has declined in last 50 years
● More common in high risk areas
● Risk factors: diet containing nitrates, smoked and salted foods, pickled vegetables, lack of citrus fruit, lack of green leafy vegetable; also low socioeconomic status, cigarette smoking [RR: 1.5-3.0 x]
● Host factors: chronic gastritis (intestinal metaplasia is a precursor lesion), H pylori infection, autoimmune gastritis, partial gastrectomy (favors reflux), gastric adenomas
● Other risk factors: slightly increased risk with blood group A, family history, hereditary nonpolyposis colon cancer syndrome
● Not a risk factor: alcohol, antacids, occupational exposure
Advanced gastric carcinoma
● Neoplastic intestinal glands resembling colonic adenocarcinoma
● Contain apical mucin vacuoles
● Variable calcification, endocrine cells, rare Paneth cells
● Well differentiated: columnar cells secrete mucin, rarely are ciliated; may mimic complete intestinal metaplasia and need multiple biopsies, but carcinoma has tubules with branching, tortuous, anastomosing and plexiform structures (Hum Pathol 1999;30:826)
● Poorly differentiated: solid pattern
● Acid mucins (Alcian Blue, colloidal iron), p53 (usually)
End of Stomach > Carcinoma > Intestinal type adenocarcinoma
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