Background:Gastric adenocarcinoma(GA)is a heterogeneous tumor,and the accurate classification of GA is important.Previous classifications are based on molecular analysis and have not focused on GA with the primitive e...Background:Gastric adenocarcinoma(GA)is a heterogeneous tumor,and the accurate classification of GA is important.Previous classifications are based on molecular analysis and have not focused on GA with the primitive enterocyte phenotype(GAPEP),a unique subtype with a poor prognosis and frequent liver metastases.New substituted molecular(SM)classifications based on immunohistochemistry(IHC)are needed.Methods:According to the IHC staining results,we divided 582 cases into six types:mismatch repair deficient(dMMR),Epstein-Barr virus associated(EBVa),the primitive enterocyte phenotype(PEP),the epithelial mes-enchymal transition(EMT)phenotype,not otherwise specified/P53 mutated(NOS/P53m)and not otherwise specified/P53 wild-type(NOS/P53w).We analyzed the clinicopathological features,the immune microenviron-ment(PD-L1,CD8)and expression of HER2 and VEGFR2 of those types.Results:There were 31(5.3%)cases of the dMMR type,13(2.2%)cases of the EBVa type,44(7.6%)cases of the PEP type,122(21.0%)cases of the EMT type,127(21.8%)cases of the NOS/P53m type and 245(42.1%)cases of the NOS/P53w type.Patients with the dMMR type had the best survival(P<0.001).Patients with the EBVa type were younger(P<0.001)and had higher PD-L1 and CD8 expression(P<0.001)than other patients.Patients with the EMT type exhibited poor differentiation and a higher rate of abdominal metastasis.Patients with the NOS/P53m and PEP types had the worst survival rates and the highest PD-L1/HER2/VEGFR2 expression levels among all patients(P<0.001).Conclusion:Different SM classifications have different clinicopathological features and expression patterns,which indicate the probable clinical treatment strategies for these subtypes.展开更多
Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension...Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.展开更多
基金supported by the Peking Union Medical College Youth Fund(2017320030)the Beijing Hope Run Special Fund(No.LC2018A12),the CAMS Initiative for Innovative Medicine(CIFMS)(No.2016-I2M-3-005)+1 种基金the Medical and Health Science and Tech-nology Innovation Project of the Chinese Academy of Medical Sci-ences(2016-12M-1-007)the China International Medical Exchange Foundation Xiansheng Anti-Tumor Therapy Special Research Fund(cimf-f-h001-314).
文摘Background:Gastric adenocarcinoma(GA)is a heterogeneous tumor,and the accurate classification of GA is important.Previous classifications are based on molecular analysis and have not focused on GA with the primitive enterocyte phenotype(GAPEP),a unique subtype with a poor prognosis and frequent liver metastases.New substituted molecular(SM)classifications based on immunohistochemistry(IHC)are needed.Methods:According to the IHC staining results,we divided 582 cases into six types:mismatch repair deficient(dMMR),Epstein-Barr virus associated(EBVa),the primitive enterocyte phenotype(PEP),the epithelial mes-enchymal transition(EMT)phenotype,not otherwise specified/P53 mutated(NOS/P53m)and not otherwise specified/P53 wild-type(NOS/P53w).We analyzed the clinicopathological features,the immune microenviron-ment(PD-L1,CD8)and expression of HER2 and VEGFR2 of those types.Results:There were 31(5.3%)cases of the dMMR type,13(2.2%)cases of the EBVa type,44(7.6%)cases of the PEP type,122(21.0%)cases of the EMT type,127(21.8%)cases of the NOS/P53m type and 245(42.1%)cases of the NOS/P53w type.Patients with the dMMR type had the best survival(P<0.001).Patients with the EBVa type were younger(P<0.001)and had higher PD-L1 and CD8 expression(P<0.001)than other patients.Patients with the EMT type exhibited poor differentiation and a higher rate of abdominal metastasis.Patients with the NOS/P53m and PEP types had the worst survival rates and the highest PD-L1/HER2/VEGFR2 expression levels among all patients(P<0.001).Conclusion:Different SM classifications have different clinicopathological features and expression patterns,which indicate the probable clinical treatment strategies for these subtypes.
文摘Advanced gastric cancer usually presents with symptoms due to direct extension into adjacent viscera, distant metastases from lymphatic or hematogenic dissemination and peritoneal seeding. However, portal hypertension as a presentation of metastatic gastric cancer is rare and usually seen in association with other malignancies, e.g. hepatocellular and pancreatic carcinoma. We report a case of signet ring adenocarcinoma of the stomach that presented with esophageal and duodenal varices and bleeding due to portal hypertensive gastropathy. Pagetoid spread of cancer cells likely caused early metastasis and the unusual presentation. We also discussed the pathophysiology of development of portal hypertension in association with malignancies.
