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Video Endoscopic Sequence 1 of 6.
Gastric Cancer with signet ring cells
A 75 year-old Female, presented with abdominal pain. nausea, vague discomfort in the abdomen, and weight loss of 8 pounds, an upper endoscopy is performed, finding an irregular ulcer in the anterior wall with thickened folds and infiltration of incisura angularis.
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.
mach cancer is the fifth most common cancer in Europe with 159 900 new cases and 118 200 deaths reported in 2006.
Theuer CP, de Virgilio C, Keese G, French S, Arnell T, Tolmos J, Klein S, Powers W, Oh T, Stabile BE
Am J Surg. 1996 Nov; 172(5):473-6; discussion 476-7.
[PubMed] [Ref list]
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Secuencia Video Endoscópica 2 de 6.
Gastric Cancer with signet ring cells
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Secuencia Video Endoscópica 3 de 6.
Gastric Cancer Surgical Specimen
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Secuencia Video Endoscópica 4 de 6.
Gastric Cancer Surgical Specimen
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Secuencia Video Endoscópica 5 de 6.
Gastric Cancer with signet ring cells
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Secuencia Video Endoscópica 6 de 6.
Gastric Cancer with signet ring cells
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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.
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.
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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.
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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.
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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%).
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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.
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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
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Video Endoscopic Sequence 7 of 8.
Adenocarcinoma of the lesser curvature with signet-ring cells.
Chromoendoscopy using indigo carmin.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Video Endoscopic Sequence 3 of 3.
Biopsy revealed the lesion to be adenocarcinoma.
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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.
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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.
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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.
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Video Endoscopic Sequence 4 of 25.
Adenocarcinoma of the cardias and gastric fundus with signet-ring cells.
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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.
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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. |
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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
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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
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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
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Video Endoscopic Sequence 10 of 25.
Gastric Cancer Surgical Specimen
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Video Endoscopic Sequence 11 of 25.
Gastric Cancer Surgical Specimen
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Video Endoscopic Sequence 12 of 25.
Gastric Cancer Surgical Specimen
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Video Endoscopic Sequence 13 of 25.
Gastric Cancer Surgical Specimen
There is an ulcer at the gastroesophageal junction.
The antral mucosa is edematous.
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Video Endoscopic Sequence 14 of 25.
Gastric Cancer Surgical Specimen
This view shows the irregular border of the ulcer at the esophagogastric junction.
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Video Endoscopic Sequence 15 of 25.
Gastric Cancer Surgical Specimen
It is shown the fundus of the neoplasia with irregular and
granular surface.
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Video Endoscopic Sequence 16 of 25.
Gastric Cancer Surgical Specimen
This view shows the irregular border of the ulcer
at the esophagogastric junction.
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Video Endoscopic Sequence 17 of 25.
Gastric Cancer Surgical Specimen
It is shown the fundus of the neoplasia with irregular and granular surface.
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Video Endoscopic Sequence 18 of 17.
There is a slight malignant epithelial infiltrates into the lamina propria.
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Video Endoscopic Sequence 19 of 25.
It is clearly visible the malignant epithelial cells at the muscular propria. |
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Video Endoscopic Sequence 20 of 25.
There are mucosecreting malignant glands.
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Video Endoscopic Sequence 21 of 25.
There are malignant epithelial cells, some of them wit clear cytoplasm.
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Video Endoscopic Sequence 22 of 25.
Picture of a metastatic glandular neoplasia to lymph nodes.
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Video Endoscopic Sequence 23 of 25.
The ring shape of the epithelial malignant cells is the predominant histologic pattern.
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Video Endoscopic Sequence 24 of 25.
Picture of a metastatic glandular neoplasia to lymph nodes.
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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
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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.
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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.
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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.
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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.
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Video Endoscopic Sequence 2 of 2.
Ulcerated Gastric Carcinoma of the fundus retroflexed view.
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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
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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.
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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. |
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Video Endoscopic Sequence 3 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
Another image of this lesion, multiple biopsies were taken
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Video Endoscopic Sequence 4 of 19.
Biopsies revealed the lesion to be adenocarcinoma.of
diffusely infiltrating, poorly differentiated.
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Video Endoscopic Sequence 5 of 19.
Biopsies revealed adenocarcinoma with signet ring cells.
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Video Endoscopic Sequence 6 of 19.
Gastric adenocarcinoma with signet ring cells.
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Video Endoscopic Sequence 7 of 19.
Alcian Blue Stains Showing Signet Ring Cells.
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Video Endoscopic Sequence 8 of 19.
Positive Cytokeratin.
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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.
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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
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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.
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Video Endoscopic Sequence 12 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
To Enlarged the image in a new window click on it
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Video Endoscopic Sequence 13 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
To Enlarged the image in a new window click on it |
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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.
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Video Endoscopic Sequence 15 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
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Video Endoscopic Sequence 16 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell |
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Video Endoscopic Sequence 17 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
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Video Endoscopic Sequence 18 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
Transversal cut.
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Video Endoscopic Sequence 19 of 19.
Gastric Adenocarcinoma of the Diffuse Ring Cell
To enlarge the image in a new window press on it
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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 .
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Video Endoscopic Sequence 2 of 12.
There is an irregular and ulcerated nodule in the antrum
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Video Endoscopic Sequence 3 of 12.
Adenocarcinoma of the Antrum and incisura angularis
Another image and video of the nodule in the antrum
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Video Endoscopic Sequence 4 of 12.
Surgical specimen, showing the neoplasia at the antrum.
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Video Endoscopic Sequence 5 of 12.
Adenocarcinoma of the Antrum and incisura angularis
Cross Section of the neoplasm
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Video Endoscopic Sequence 6 of 12.
Adenocarcinoma of the Antrum and incisura angularis
Cross Section of one of the ulcerated nodules
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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
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Video Endoscopic Sequence 8 of 12.
Adenocarcinoma of the Antrum and incisura angularis
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Video Endoscopic Sequence 9 of 12.
Adenocarcinoma of the Antrum and incisura angularis
Transversal Cut.
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Video Endoscopic Sequence 10 of 12.
Adenocarcinoma of the Antrum and incisura angularis
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Video Endoscopic Sequence 11 of 12.
Adenocarcinoma of the Antrum and incisura angularis
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Video Endoscopic Sequence 12 of 12.
Adenocarcinoma of the Antrum and incisura angularis
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Video Endoscopic Sequence 1 of 7.
Recurrent adenocarcinoma
A 67-year-old male patient presented gastric Signet ring cell carcinoma of the antrum and gastric body. He underwent surgery with a sub-total gastrectomy. 8 months later, begins with repeated vomiting, a new endoscopy is performed, finding obstruction of the cardia.
While the incidence of gastric cancer has decreased worldwide in recent decades, the incidence of signet-ring cell carcinoma (SRCC) is rising. SRCC has a specific epidemiology and oncogenesis and has two forms: early gastric cancer, which can be resected endoscopically in some cases and which has a better outcome than non-SRCC, and advanced gastric cancer, which is generally thought to have a worse prognosis and lower chemosensitivity than non-SRCC. However, the prognosis of SRCC and its chemosensitivity with specific regimens are still controversial as SRCC is not specifically identified in most studies and its poor prognosis may be due to its more advanced stage. It therefore remains unclear if a specific therapeutic strategy is justified, as the benefit of perioperative chemotherapy and the value of taxane-based chemotherapy are unclear. In this review we analyze recent data on the epidemiology, oncogenesis, prognosis and specific therapeutic strategies in both early and advanced SRCC of the stomach and in hereditary diffuse gastric cancer.
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Video Endoscopic Sequence 2 of 7.
Dilation with hydrostatic balloon
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Video Endoscopic Sequence 3 of 7.
The cardia is dilated and advance the endoscope to the gastro-jejunal anastomosis
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Video Endoscopic Sequence 4 of 7.
Recurrence of the neoplasia in the fundus and the two loops of the Gastrojejunal Anastomosis are permeable.
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Video Endoscopic Sequence 5 of 7.
Adenocarcinoma recurrente del cardias y fondo gástrico
Se observa infiltración neoplásica del fondo gástrico. |
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Video Endoscopic Sequence 6 of 7.
Se realiza una maniobra de retroflexión en una de las asas de yeyuno examinando hasta el fondo gástrico, descargar el video.
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Video Endoscopic Sequence 7 of 7.
Imagen en retroflexión visualizando el fondo con el cáncer recurrente
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