Case 3

Carton, Daly & Ramani: Clinical Pathology - Case Studies
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3. Case 3
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10. Case 10

Case 3

Image: gastrectomy specimen

This is a gastrectomy specimen from a patient showing a large ulcerated gastric carcinoma arising in the body of the stomach.

Question 1

Which of the following are true about the symptoms and diagnosis of gastric carcinoma? (Tick all those that apply)

	a)	Most patients in Western countries have advanced carcinomas at the time of presentation.
	b)	Tumours that obstruct the gastric outlet may cause persistent vomiting.
	c)	Gastric carcinomas are found in about 10% of patients undergoing endoscopy for persistent dyspepsia.
	d)	An experienced endoscopist can reliably distinguish between an ulcerated gastric carcinoma and a gastric peptic ulcer.
Correct. Some 80-90% of all patients in Western countries have advanced carcinomas by the time of presentation. Symptoms of advanced gastric carcinoma include persistent abdominal pain unrelieved by eating with systemic symptoms of weight loss and anorexia. Tumours obstructing the gastric outlet cause may cause vomiting. Dyspepsia is a very common and non-specific symptom; gastric carcinoma is found in only some 1-2% of all patients undergoing endoscopy for persistent dyspepsia. Even an experienced endoscopist cannot reliably distinguish between ulcerated carcinomas and peptic ulcers and so multiple biopsies should be taken from the edge of any ulcerated lesion in the stomach to exclude malignancy. Incorrect. Some 80-90% of all patients in Western countries have advanced carcinomas by the time of presentation. Symptoms of advanced gastric carcinoma include persistent abdominal pain unrelieved by eating with systemic symptoms of weight loss and anorexia. Tumours obstructing the gastric outlet cause may cause vomiting. Dyspepsia is a very common and non-specific symptom; gastric carcinoma is found in only some 1-2% of all patients undergoing endoscopy for persistent dyspepsia. Even an experienced endoscopist cannot reliably distinguish between ulcerated carcinomas and peptic ulcers and so multiple biopsies should be taken from the edge of any ulcerated lesion in the stomach to exclude malignancy. Your answer has been saved.

Question 2

Which of the following are true about risk factors for gastric carcinoma? (Tick all those that apply)

	a)	The major risk factor is an antral predominant gastritis caused by Helicobacter pylori infection.
	b)	Patients with autoimmune gastritis are at increased risk.
	c)	Only a small proportion arise from gastric adenomas.
	d)	Dietary factors do not appear to be important.
Correct. Most gastric carcinomas arise from a background of atrophic gastritis, most often caused by a chronic corpus predominant gastritis associated with Helicobacter pylori infection. Patients with autoimmune gastritis are also at risk, as this can also lead to an atrophic gastritis. The adenoma-carcinoma sequence is much less important in the stomach than in the colon and rectum. Diet has been consistently associated with gastric carcinoma. An adequate intake of fresh fruits and vegetables lowers the risk, and high salt intake increases the risk. Incorrect. Most gastric carcinomas arise from a background of atrophic gastritis, most often caused by a chronic corpus predominant gastritis associated with Helicobacter pylori infection. Patients with autoimmune gastritis are also at risk, as this can also lead to an atrophic gastritis. The adenoma-carcinoma sequence is much less important in the stomach than in the colon and rectum. Diet has been consistently associated with gastric carcinoma. An adequate intake of fresh fruits and vegetables lowers the risk, and high salt intake increases the risk. Your answer has been saved.

Question 3

Which of the following are true about the different types of gastric carcinoma? (Tick all those that apply)

	a)	The intestinal type is preceded by a phase of dysplasia in an area of intestinal metaplasia.
	b)	The intestinal type is rising in incidence.
	c)	Signet ring cells may be seen in the diffuse type.
	d)	The intestinal type is more aggressive than the diffuse type.
Correct. The intestinal type of gastric carcinoma arises through the sequence of chronic atrophic gastritis, intestinal metaplasia, dysplasia, and carcinoma. This type of carcinoma is falling in incidence, probably due to increased eradication of Helicobacter pylori infection. The diffuse type is characterized microscopically by discohesive cells, many of which are distended with mucin creating the signet ring cell morphology microscopically. The diffuse type tends to widely disseminate and behave more aggressively than the intestinal type. Page reference for whole case study: 147-9 Incorrect. The intestinal type of gastric carcinoma arises through the sequence of chronic atrophic gastritis, intestinal metaplasia, dysplasia, and carcinoma. This type of carcinoma is falling in incidence, probably due to increased eradication of Helicobacter pylori infection. The diffuse type is characterized microscopically by discohesive cells, many of which are distended with mucin creating the signet ring cell morphology microscopically. The diffuse type tends to widely disseminate and behave more aggressively than the intestinal type. Page reference for whole case study: 147-9 Your answer has been saved.

Carton, Daly & Ramani: Clinical Pathology - Case Studies

Table of Contents

Case 3

Question 1

Question 2

Question 3