Gastric Cancer
Adenocarcinoma that infiltrates the Cardias and the

Video Endoscopic Sequence 1 of 2.

Adenocarcinoma that infiltrates the Cardias and the Fundus.

This lady of 87 year-old, presented with dysphagia to solids and liquids, anorexia and anemia.

 

Adenocarcinoma that infiltrates the Cardias and the

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Endoscopic image of adenocarcinoma of the gastric fundus

Video Endoscopic Sequence 2 of 2.

Endoscopic image of adenocarcinoma of the gastric fundus

These image shows a ulcerated malignant tumor in the gastric fundus, (adenocarcinoma) retroflexed image.


Barrett Adenocarcinoma.

Video Endoscopic Sequence 1 of 4.

Barrett Adenocarcinoma.

This 85 year-old male, presented with dysphagia to solids and liquids, having a medical record to have been sufering long standing GERD.

 

 

Endoscopy of Barrett Adenocarcinoma

Video Endoscopic Sequence 2 of 4.

Endoscopy of Barrett Adenocarcinoma

 

 

 

 

 

Endoscopy of Barrett Adenocarcinoma

Video Endoscopic Sequence 3 of 4.

Endoscopy of Barrett Adenocarcinoma

The gastric cardias is infitrated by the neoplasia, retroflexed image.

 


Endoscopy of Barrett Adenocarcinoma

Video Endoscopic Sequence 4 of 4.

Endoscopy of Barrett Adenocarcinoma

Long Segment of Barrett´s Esophagus magnification endoscopy.





Endoscopic image of Barrett Adenocarcinoma

 ideo Endoscopic Sequence 1 of 20.

Endoscopic image of Barrett Adenocarcinoma

This 61 year-old male who four years previously, had made the diagnosis of Barrett's esophagus and has history of longstanding gastroesophageal reflux disease, to the point that the patient sleep almost sit, neither had received treatment with inhibitors of the proton pump inhibitors, or any endoscopic follow up.

At the time of this endoscopy, had 15 days suffering of dysphagia.

 

Endoscopic image of Barrett Adenocarcinoma





Barrett Adenocarcinoma

Video Endoscopic Sequence 2 of 20.

Image and Video Clip of Barrett Adenocarcinoma

In the image and the video clip shows a tongue of Barrett's esophagus of a long segment and the extensive malignant infiltration and a hiatus hernia

Over time the relative distribution of cancers of the proximal digestive tract has changed. Squamous cell carcinomas of the esophagus have become less common, while numbers of adenocarcinomas have greatly increased. This shift most likely reflects an increase in the incidence of gastroesophageal reflux. Moreover, there is a decline in the incidence of distal gastric cancer, which in turn may be related to Heliobacter pylori eradication.


Endoscopic image of Barrett Adenocarcinoma

Video Endoscopic Sequence 3 of 20.

In this video clip you can see, the extensive malignant infiltration, retroflexed image.

Simultaneously, there is a time trend toward a more proximal localization of gastric cancer. If the above-mentioned etiopathologic links are correct, this could indicate that the so-called cardia adenocarcinomas are not related to H pylori infection and that they may instead be related to gastroesophageal reflux and eventually may not be considered to be "gastric" cancers.

 



Endoscopic image of Barrett Adenocarcinoma

  Video Endoscopic Sequence 4 of 20.

Endoscopic image of Barrett Adenocarcinoma

In this video clip you can see, a tongue of the Barrett´s esophagus, which has been enhanced with acetic acid, and also shows the endoscopic biopsies.

The rapidly growing quantity of literature on this subject is, however, confounding. A major source of discordance would seem to be a Babylonian confusion of tongues concerning the terms cardia and cardiac carcinomas. Unfortunately, this confusion is also apparent in the classification systems available for staging of cancer, thus closing the "vicious" circle.


Gastric cardia adenocarcinoma

Video Endoscopic Sequence 5 of 20.

H&E

Gastric cardia adenocarcinoma, invasive mucosecretante,
intestinal type, moderately differentiated (grade 2).


Video Endoscopic Sequence 6 of 20.

 H&E

At the microscope is a mucus-secreting glandular neoplasia,

Video Endoscopic Sequence 7 of 20.

(Alcian blue positive).

 

Video Endoscopic Sequence 8 of 20.

Positive Citoqueratin +++

 



Video Endoscopic Sequence 9 of 20.

Positive Citoqueratin +++



Video clip of the surgical specimen, noting the esophagus and the gastric fundus.

Video Endoscopic Sequence 10 of 20.

Video clip of the surgical specimen, noting the esophagus and the gastric fundus.

 

Click on the image to download the video clip

 

Video Endoscopic Sequence 11 of 20.

Another video clip of the surgical specimen at the operating room.

 

 

 

 

 

 

Video Endoscopic Sequence 12 of 20.


Another video clip of part of the surgical procedure showing a clamp while cutting and stapler.

Video Endoscopic Sequence 13 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Video Endoscopic Sequence 14 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Video Endoscopic Sequence 15 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Video Endoscopic Sequence 16 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Macroscopic Specimen image of Barrett Adenocarcinoma

Video Endoscopic Sequence 17 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Video Endoscopic Sequence 18 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

The neoplasm arising in Barrett's epithelium.

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Video Endoscopic Sequence 19 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Video Endoscopic Sequence 20 of 20.

Macroscopic Specimen image of Barrett Adenocarcinoma

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Synchronous Gastric Cancer

Video Endoscopic Sequence 1 of 4.

Synchronous Gastric Cancer

Double Cardia Cancer and Adenocarcinoma of the Antrum

This is a male 63 year-old male, presented with anorexia, dysphagia, and anemia. An upper endoscopic was performed finding two neoplasms. One in esophageal cardias spread to gastric cardia and one in the anterior wall of antrum

Second primary cancer influences the prognosis of gastric cancer patients, and because primary or secondary prevention is the best way to cure cancer, some investigators have focused on the characteristics of second primary cancers in gastric cancer patients. However, few studies have been performed in this regard, and most of these studies are limited to metachronous cancers or the treatment-related second primary malignancies of gastric cancer patients]. The detection of synchronous cancers gives us the opportunity to treat both cancers simultaneously using less invasive techniques and thus to benefi cially infl uence the prognosis and quality of life of these patients.The aim of this study was to find a means of identifying gastric cancer patients at risk of having a synchronous cancer.




 

Synchronous Gastric Cancer

Video Endoscopic Sequence 2 of 4.

Synchronous Gastric Adenocarcinoma

The gastric antrum is infiltrated with a second neoplasia.

Whilst synchronous adenocarcinoma of the stomach is well documented, metachronous primary disease is exceedingly rare.

Multiple synchronous gastric carcinomas are variously described in 1-3% of patients, and they occur typically in elderly men.


Synchronous Gastric Cancer

Video Endoscopic Sequence 3 of 4.

Endoscopic image of adenocarcinoma of the Gastric Fundus

The gastric cardia is infiltrated.

Multiplicity of primary malignancies itself does not seem to indicate a poor prognosis. The early detection of additional primary malignancies will enable proper management with curative intent.

 

 

Synchronous Gastric Cancer

 Video Endoscopic Sequence 4 of 4.

Endoscopy of adenocarcinoma of the antrum second neoplasia.

 

Ulcerated adenocarcinoma of the antrum with signet ring cells..

  Video Endoscopic Sequence 1 of 10.

Ulcerated adenocarcinoma of the antrum with signet ring cells.

This a 72 year-old male, who had a crisis of lipotimia, having ruled out cardiovascular and neurological disease by their respective medical specialists, comes to our unit to continue his checkup, we had practiced an endoscopy eighteen years ago, ten years earlier he had a retro cecal and retroperitoneal appendicitis and eight years ago, he suffered from a lymphoma of the spermatic cord, subsequently received chemotherapy due to the spread of the lymphoma having achieved regression.

He had not had dyspeptic symptoms. an upper endoscopy was performed finding this tumor apparently asymptomatic.

 

Ulcerated adenocarcinoma of the antrum with signet ring cells.

  Video Endoscopic Sequence 2 of 10.

Video clip of Ulcerated adenocarcinoma of the antrum with signet ring cells.

 

Gastric cancer consists of two pathological variants, intestinal and diffuse. The intestinal-type is the end-result of an inflammatory process that progresses from
chronic gastritis to atrophic gastritis and finally to intestinal metaplasia and dysplasia. This type is more common among elderly men, unlike the diffuse type, which is
more prevalent among women and in individuals under the age of 50. The diffuse-type, characterized by the development of linitis plastica, is associated with an
unfavorable prognosis because the diagnosis is often delayed until the disease is quite advanced. Gastric H. pylori infection is highly associated with this type as with
the intestinal-type.


Ulcerated adenocarcinoma of the antrum with signet ring cells.

  Video Endoscopic Sequence 3 of 10.

Ulcerated adenocarcinoma of the antrum with signet ring cells.

95% of gastric cancers are adenocarcinomas. • The remaining 5% are lymphomas (second most common, includes MALT lymphomas), sarcomas (including leiomyosarcomas and Kaposi’s sarcomas), GISTs, carcinoids, and squamous cell carcinomas • 2 distinct histologic subtypes of gastric adenocarcinomas: intestinal, diffuse (discussed in more detail later) à Intestinal type – retained glandular structure, more localized à Diffuse type – no glandular structures, more spread out.


 

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

  Video Endoscopic Sequence 4 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

Cancer status à Worldwide: 4th most common cancer, 2nd leading cause of cancer death à In the US: 14th most common cancer, 7th most common cancer death à Incidence of intestinal type has declined rapidly over the recent few decades ? due to invention of refrigerators, with better food storage and reduced need for salt-based preservation. à Incidence of diffuse type has declined more gradually à Incidence of distal gastric cancers has decreased, but proximal (cardia) cancers have increased (some propose that these cancers are a separate entity, more closely resembling Barrett’s associated esophageal adenocarcinoma).

 

 

 

 

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Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

  Video Endoscopic Sequence 5 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells..

 

 

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Pieza macroscópica Adenocarcinoma Ulcerado del antro con células en anillo de sello.

  Video Endoscopic Sequence 6 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

 

 

Click on the image to enlarged in a new window

 

 

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

  Video Endoscopic Sequence 7 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells.

 

 

 

 

 

 

Click on the image to enlarged in a new window

 

 

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

  Video Endoscopic Sequence 8 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

 

 

Click on the image to enlarged in a new window

 

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

  Video Endoscopic Sequence 9 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

 

 

 

 

 

Click on the image to enlarged in a new window

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

  Video Endoscopic Sequence 10 of 10.

Sub total gastrectomy displaying the macroscopic specimen showing part of the antrum with Ulcerated Adenocarcinoma with signet ring cells

 

 

 

 

 

Click on the image to enlarged in a new window

 

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