Gastric Cancer
Gastric Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 1 of 8.

Gastric Adenocarcinoma of the lesser curvature with signet-ring cells.

This 34 year old female, lawyer, 4 months previously delivered her second baby previously and has another child of three years, due to an abdominal pain an upper endoscopy was performed, weight loss of 10 pounds was reported.

 

Gastric Adenocarcinoma

For more endoscopic details download the video clips by clicking on the endoscopic images, wait to be downloaded complete then press Alt and Enter that you can see the video in full screen.

All endoscopic images shown in this Atlas contain
video clips.


Gastric Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 2 of 8.

Gastric Adenocarcinoma of the lesser curvature with signet-ring cells.

Chromoendoscopy using Lugol's solution.

At the gastric angle an irregular folders are found.

The image and video display some typical parameters of
criteria of a malign ulcer.

1. Fold tapering
2. Ulcer
3. Fusion of folds
4. Abrupt termination of fold
5. Bulbous enlargement.

 

 

 


Gastric Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 3 of 8.

Endoscopy of Adenocarcinoma of the lesser curvature with signet-ring cells.

In this image and video clip is observed an irregular ulceration found it at the lesser curvature and the anterior wall of the stomach which fulfill of criteria of a malign infiltration.

The geographic incidence of gastric cancer has changed dramatically over the last few decades. Prior to 1950, it was the most common cause of cancer death in men, and the third leading cause of cancer death in women in the U.S. Mortality from gastric cancer in the United States has declined, perhaps due to dietary changes. This cancer is twice as common in men than women, twice as common in blacks than whites, and more common with advancing age.

Gastric cancer is also seen in higher rates in Latin America, Northern Europe and the Far East. It remains the second leading cause of cancer death worldwide.

Gastric cancer peaks in the seventh decade of life. Often, a delay in diagnosis may account for the poor prognosis. Fortunately, dedicated research into its pathogenesis and identification of new risk factors, treatment, and advanced endoscopic techniques have led to earlier detection of gastric cancer.

Recognition that Helicobacter pylori infection causes
most gastric ulcers has revolutionized the approach to gastric cancer today. Gastric tumors include adenocarcinoma, non-Hodgkin’s lymphoma, and carcinoid tumors.


Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 4 of 8.

Adenocarcinoma of the lesser curvature with signet-ring cells.

Another image of the folds that converges in abnormal form.

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.


Adenocarcinomas arising from gastric epithelium are the most common malignancies of the stomach (90% of cases). Malignancies arising from connective tissue
(sarcoma) and from lymphatics (lymphoma) are less common. Adenocarcinomas (Figures 2 and 3) are most often found in the gastric cardia (31%), followed by the
antrum (26%), and body of the stomach (14%).


Image and video clip of Adenocarcinoma of the lesser curvature with signet-ring cells

Video Endoscopic Sequence 5 of 8.

Image and video clip of Adenocarcinoma of the lesser curvature with signet-ring cells.

Retroflexed Image.

Adenocarcinomas are classified according to histology and location. Histologically, these malignancies may be divided into well-differentiated and poorly differentiated
types, depending on the degree of gland formation and ability to secrete mucus. Most tumors are heterogeneous in histological appearance; therefore, classification is
made by noting the predominant structures. Thus, well-differentiated tubular and poorly differentiated signet-ring cell carcinoma make up the majority of tumors. Less
common types are mucinous, papillary and undifferentiated carcinoma.


 

 

Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 6 of 8.

Adenocarcinoma of the lesser curvature with signet-ring cells.

Magnifying Endoscopy 150x.

Some ulcerated areas with neovascularization are observed


Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 7 of 8.

Adenocarcinoma of the lesser curvature with signet-ring cells.

Chromoendoscopy using indigo carmin.


Adenocarcinoma of the lesser curvature with signet-ring cells

Video Endoscopic Sequence 8 of 8.

Adenocarcinoma of the lesser curvature with signet-ring cells.

Magnifying Endoscopy 150x.

Some ulcerated areas with neovascularization, ulcerated areas, and cellular agglomerate are seen.


Gastric Cancer diffuse type with cells signet ring

Video Endoscopic Sequence 1 of 4.

Adenocarcinoma of the lesser curvature with signet ring cells.

This 30 year old female, 10 months previously delivered her first baby. The first appointment was due to a feeling of abdominal distention, with no other symptoms or weight loss, an abdominal ultrasound was performed finding moderate ascites, an upper endoscopy was carry out finding the images and video clip here shown, biopsies revealed to be of the diffuse type adenocarcinoma with cells signet ring.

 

 

Gastric Cancer

Video Endoscopic Sequence 2 of 4.

Gastric Cancer diffuse type with cells signet ring.

In young patients gastric cancer is usually diffuse variety with signet ring cells and in this case the only symptom was abdominal distention without any other symptoms.




Gastric Cancer diffuse type with cells signet ring

Video Endoscopic Sequence 3 of 4.

Gastric Cancer diffuse type with cells signet ring.

In this image as well as the video clip display infiltration of the tumor to the gastric fundus located in the lesser curvature and anterior wall.


Gastric Cancer diffuse type with cells signet ring

Video Endoscopic Sequence 4 of 4.

Gastric Cancer diffuse type with cells signet ring.

Image and video clip with abnormally converging folds, there is thickening of tissues and infiltration to the fundus and gastric cardia side.

 

Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 1 of 3.

Adenocarcinoma of the lesser curvature with signet-ring cells.

This 56 year-old man, who two months previously initiates sintomatology with loss weight, satiety and postprandial vomiting.


Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 2 of 3.

Adenocarcinoma of the lesser curvature with signet-ring cells.

In this image and video clip is seen an irregular ulceration of the body and antrum.


Adenocarcinoma of the lesser curvature with signet-ring cells.

Video Endoscopic Sequence 3 of 3.

Adenocarcinoma of the lesser curvature with signet-ring cells.

In this image as well as the video clip you can seen another view of the neoplasia.



Endoscopy of Obstructed Gastric Cancer

Video Endoscopic Sequence 1 of 3.

Endoscopy of Obstructed Gastric Cancer

In this endoscopic sequence a reflux esophagitis is
observed due to an obstructed gastric cancer of the antrum.


An ulcerated obstructed neoplasia is seen at the gastric antrum.

Video Endoscopic Sequence 2 of 3.

An ulcerated obstructed neoplasia is seen at the gastric antrum.

This 56 year- old male, who presented with early satiety and postprandial vomiting, suggestive of gastric outlet obstruction, along with weight loss and anemia. Endoscopy demonstrated an ulcerated mass.

 

Biopsy revealed the lesion to be adenocarcinoma.

Video Endoscopic Sequence 3 of 3.

Biopsy revealed the lesion to be adenocarcinoma.

 

 

 


Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

Video Endoscopic Sequence 1 of 25.

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

A 34 year-old male, who presented dysphagia for solids and liquids.


Adenocarcinoma of the cardias and gastric fundus with signet-ring cells

Video Endoscopic Sequence 2 of 25.

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

In the retroflexed image a large ulcerated tumor is observed at the gastric fundus.

 

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

Video Endoscopic Sequence 3 of 25.

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

The gastric cardias is observed with extensive infiltration.

 

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

Video Endoscopic Sequence 4 of 25.

Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.

 


esofagogastrectomy

Video Endoscopic Sequence 5 of 25.

Patient undergoing esofagogastrectomy

This sequence of images represents the surgical specimen in our case of gastric cancer.

 

Click on the image to enlarge in a new window.

 

 


Gastric Cancer Surgical Specimen

Video Endoscopic Sequence 6 of 25.

Gastric Cancer Surgical Specimen

The prognosis following surgical resection depends on the stage at presentation. Early tumors confined to the stomach lining have higher cure rates than cases in
which disease has already spread to distant sites or regional lymph nodes. Cure rates have improved in the past 30 years, particularly in Japan. These improvements
can be attributed mainly to an increase in early detection rates.

Click on the image to enlarge in a new window.

Gastric Cancer Surgical Specimen

Video Endoscopic Sequence 7 of 25.

Gastric Cancer Surgical Specimen

The type of surgery performed depends on the extent and location of tumor; therefore, preoperative evaluation is critical. Initial staging may be established by endoscopy with biopsy. Endoscopic ultrasound should follow. Endoscopic Ultrasound (EUS) has a sensitivity of 85% in assessing depth of tumor invasion and detecting nodal involvement prior to surgery. Laparoscopic staging prior to surgical resection is also advocated and has impacted preoperative treatment decisions. There are two principle types of gastric resection—the subtotal gastrectomy and the total gastrectomy. Determination of the type of resection depends on various factors including: 1) the location of the tumor, 2) the size and the extent of the tumor, and 3) the histology pattern.

 

 

 

 

 

To enlarge the image in a new window press on it

Gastric Cancer Surgical Specimen

Video Endoscopic Sequence 8 of 25.

Gastric Cancer Surgical Specimen

In addition to removal of the stomach, resections with curative intent generally include lymphadenectomy, or removal of regional lymph nodes. Controversy remains as to the extent of the lymphadenectomy required. Some advocate removal of nodes adjacent to the stomach (D1 dissection, while some centers, particularly in Japan, advocate more radical lymphadenectomy.

 

 

 

 

To enlarge the image in a new window press on it


Gastric Cancer Surgical Specimen

Video Endoscopic Sequence 9 of 25.

Gastric Cancer Surgical Specimen

Occasionally, adjacent organs may need to be removed, including the spleen, omentum and liver. Following gastrectomy, intestinal continuity is restored using a variety of reconstruction techniques. When only the distal stomach is removed, reconstruction can be achieved by a Billroth II gastrojejunostomy.

 

 

 

 

To enlarge the image in a new window press on it


Video Endoscopic Sequence 10 of 25.

Gastric Cancer Surgical Specimen

 

Video Endoscopic Sequence 11 of 25.

Gastric Cancer Surgical Specimen

 

Gastric Cancer Surgical Specimen

Video Endoscopic Sequence 12 of 25.

Gastric Cancer Surgical Specimen


















 

Video Endoscopic Sequence 13 of 25.

Gastric Cancer Surgical Specimen

There is an ulcer at the gastroesophageal junction.
The antral mucosa is edematous.

 

 

Video Endoscopic Sequence 14 of 25.

Gastric Cancer Surgical Specimen

This view shows the irregular border of the ulcer at the esophagogastric junction.

 

 

Video Endoscopic Sequence 15 of 25.

Gastric Cancer Surgical Specimen

It is shown the fundus of the neoplasia with irregular and
granular surface.

 

Video Endoscopic Sequence 16 of 25.

Gastric Cancer Surgical Specimen

This view shows the irregular border of the ulcer
at the esophagogastric junction.


Video Endoscopic Sequence 17 of 25.

Gastric Cancer Surgical Specimen

It is shown the fundus of the neoplasia with irregular and granular surface.


Video Endoscopic Sequence 18 of 17.

There is a slight malignant epithelial infiltrates into the lamina propria.

 

Video Endoscopic Sequence 19 of 25.

It is clearly visible the malignant epithelial cells at the muscular propria.

Video Endoscopic Sequence 20 of 25.

There are mucosecreting malignant glands.


Video Endoscopic Sequence 21 of 25.

There are malignant epithelial cells, some of them wit clear cytoplasm.


Video Endoscopic Sequence 22 of 25.

Picture of a metastatic glandular neoplasia to lymph nodes.


Video Endoscopic Sequence 23 of 25.

The ring shape of the epithelial malignant cells is the predominant histologic pattern.


Video Endoscopic Sequence 24 of 25.

Picture of a metastatic glandular neoplasia to lymph nodes.


esophagectomy

Video Endoscopic Sequence 25 of 25.

One year after the surgery a follow up endoscopy was performed finding this malign nodule at the distal esophagus.

The patient was re-intervened with distal esophagectomy

 

Ulcerated Gastric Adenocarcinoma of the gastric incisure.

Ulcerated Gastric Adenocarcinoma of the gastric incisure.

A 60 year-old female with weight loss and vomiting. Ulcerated Gastric Adenocarcinoma of the gastric incisure with signet ring cell.



Endoscopy of Ulcerated Gastric Adeno-Carcinoma at the gastric angle

Video Endoscopic Sequence 1 of 2.

Endoscopy of Ulcerated Gastric Adeno-Carcinoma at the gastric angle

A 52 year-old female with epigastric pain and vomiting. No weight loss was reported. The morphological appearance was that of a big ulcer with suspected malignancy. However, multiple biopsies of the first endoscopy did not reveal any malignant cells. Our recommendation was to repeat the endoscopy in six week.

 


Ulcerated Gastric Adeno-Carcinoma intestianal Type

Video Endoscopic Sequence 2 of 2.

Ulcerated Gastric Adeno-Carcinoma intestianal Type

The patient did not improve her symptoms. We had recommended a new endoscopy after the treatment. The malignant appearance became even more obvious after two months.

Biopsies of gastric ulcer must be taken at least twice, even when only an ulcer scar is visible at the second examination. This is because often the presence of abundant necrosis causes false negative biopsies.

 

 

 

 


Gastric Cancer

Video Endoscopic Sequence 1 of 2.

A tablet of ciprofloxacine

A 57 year-old female who had history of a previous upper gastrointestinal endoscopies over several years, performed elsewhere. On her visit to our clinic, she complained of epigastric pain and disuria. A severe urinary tract infection was detected and ciprofloxacine was prescribed. The next morning an upper gastrointestinal endoscopy was performed, a tablet of ciprofloxacine taken at 3 am, was found at the cardias ( endoscopy was performed at 9.11 am) The tablet still seen in the esophagus, which is not considered normal, since food and medicines travel immediately to the stomach after being ingested. Therefore, the suspicion of a disease in this region arises.










Ulcerated Gastric Carcinoma of the fundus retroflexed

Video Endoscopic Sequence 2 of 2.

Ulcerated Gastric Carcinoma of the fundus retroflexed view.

 

Ulcerated Gastric Adeno-Carcinoma.

Ulcerated Gastric Adeno-Carcinoma.

A 66 year-old male with abdominal pain, nausea, vomiting and weight loss.
An ulcerated gastric carcinoma at the corpus was found

 

Small Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 1 of 19.

Small Gastric Adenocarcinoma of the Diffuse Ring Cell

This 69 year-old female, who had been suffered of epigastric pain since two months, there was no weight loss, endoscopy was performed found a small and irregular ulcerated area, multiple biopsies were taken.


Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 2 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

The endoscopy revealed an irregular ulcer of the posterior wall of the gastric antrum.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 3 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Another image of this lesion, multiple biopsies were taken


Video Endoscopic Sequence 4 of 19.

Biopsies revealed the lesion to be adenocarcinoma.of
diffusely infiltrating, poorly differentiated.


Gastric Adenocarcinoma of the Diffuse Ring Cell1

Video Endoscopic Sequence 5 of 19.

Biopsies revealed adenocarcinoma with signet ring cells.


Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 6 of 19.

Gastric adenocarcinoma with signet ring cells.

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 7 of 19.

Alcian Blue Stains Showing Signet Ring Cells. 

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 8 of 19.

Positive Cytokeratin.

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 9 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Surgical Specimen

It is noted subtotal gastrectomy specimen found small malignant ulceration

To enlarge the images in a new window click on them.

 

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 10 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Another image of the tumor

To enlarge the images in a new window pressure on them


Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 11 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Neoplastic infiltration showing the malign ulcer was 1.0 cm
X 1.5 cm.


Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 12 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

To Enlarged the image in a new window click on it

 

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 13 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

 

To Enlarged the image in a new window click on it

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 14 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

The depth of infiltration was up to the subserosa but not invading the peritoneum.


Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 15 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 16 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 17 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

 

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 18 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Transversal cut.

Gastric Adenocarcinoma of the Diffuse Ring Cell

Video Endoscopic Sequence 19 of 19.

Gastric Adenocarcinoma of the Diffuse Ring Cell

 

To enlarge the image in a new window press on it

 

Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 1 of 12.

Adenocarcinoma of the Antrum and incisura angularis

This 73 year-old male presented with one month of epigastric pain.

Endoscopy demonstrated two irregular and ulcerated nodules, the lesion was an adenocarcinoma invasive poorly differentiated of the intestinal type .



Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 2 of 12.

There is an irregular and ulcerated nodule in the antrum


Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 3 of 12.

Adenocarcinoma of the Antrum and incisura angularis

Another image and video of the nodule in the antrum


Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 4 of 12.

Surgical specimen, showing the neoplasia at the antrum.


Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 5 of 12.

Adenocarcinoma of the Antrum and incisura angularis

Cross Section of the neoplasm

 

Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 6 of 12.

Adenocarcinoma of the Antrum and incisura angularis

Cross Section of one of the ulcerated nodules


Adenocarcinoma of the Antrum and incisura angularis1

Video Endoscopic Sequence 7 of 12.

Adenocarcinoma of the Antrum and incisura angularis

A close up to the ulceration

 

To enlarge the image in a new window click on it

 

Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 8 of 12.

Adenocarcinoma of the Antrum and incisura angularis

 

Adenocarcinoma of the Antrum and incisura angularis

Video Endoscopic Sequence 9 of 12.

Adenocarcinoma of the Antrum and incisura angularis

Transversal Cut.

Gastric Adenocarcinoma

Video Endoscopic Sequence 10 of 12.

Adenocarcinoma of the Antrum and incisura angularis

 

Gastric Adenocarcinoma

Video Endoscopic Sequence 11 of 12.

Adenocarcinoma of the Antrum and incisura angularis

 

Gastric Adenocarcinoma

Video Endoscopic Sequence 12 of 12.

Adenocarcinoma of the Antrum and incisura angularis

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