Consensus on the pathological definition and classification of poorly cohesive gastric carcinoma
Background and aims
Clinicopathological characteristics of gastric cancer (GC) are changing, especially in the West with a decreasing incidence of distal, intestinal-type tumours and the corresponding increasing proportion of tumours with Laurén diffuse or WHO poorly cohesive (PC) including signet ring cell (SRC) histology. To accurately assess the behaviour and the prognosis of these GC subtypes, the standardization of pathological definitions is needed.
A multidisciplinary expert team belonging to the European Chapter of International Gastric Cancer Association (IGCA) identified 11 topics on pathological classifications used for PC and SRC GC. The topics were debated during a dedicated Workshop held in Verona in March 2017. Then, through a Delphi method, consensus statements for each topic were elaborated.
A consensus was reached on the need to classify gastric carcinoma according to the most recent edition of the WHO classification which is currently WHO 2010. Moreover, to standardize the definition of SRC carcinomas, the proposal that only WHO PC carcinomas with more than 90% poorly cohesive cells having signet ring cell morphology have to be classified as SRC carcinomas was made. All other PC non-SRC types have to be further subdivided into PC carcinomas with SRC component (< 90% but > 10% SRCs) and PC carcinomas not otherwise specified (< 10% SRCs).
The reported statements clarify some debated topics on pathological classifications used for PC and SRC GC. As such, this consensus classification would allow the generation of evidence on biological and prognostic differences between these GC subtypes.
KeywordsGastric cancer Poorly cohesive sub-type Signet ring cell histology
Baiocchi Gian Luca (University of Brescia, Brescia, Italy); Bencivenga Maria (University of Verona, Verona, Italy), Flejou Jean-Francois (Hôpitaux Universitaires Est Parisien, Hôpital Saint-Antoine, Paris, France); Fumaglli Uberto (Spedali Civili, Brescia, Italy); Hoelscher Arnulf (Agaplesion Markus Krankenhaus, Frankfurt, Germany); Iglesias Mar (Hospital Universitario del Mar, Barcelona, Spain); Marrelli Daniele (University of Siena, Siena, Italy); Moenig Stephan (Hôpitaux Universitaires de Genève, Genève, Switzerland); Morgagni Paolo (G.B. Morgagni-L Pierantoni Hospital, Forlì, Italy); Pera Manuel (Hospital Universitario del Mar, Barcelona, Spain); Piessen Giullaume (University Hospital of Lille, Lille, France); Reim Daniel (Klinikum Rechts der Isar der Technischen Universität München, Munich, Germany); Renaud Florence (University Hospital of Lille, Lille, France); Roviello Franco (University of Siena, Siena, Italy); Saragoni Luca (G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy); Scarpa Aldo (University of Verona, Verona, Italy); Schneider Paul (Hirslanden Hospital Zurich, Switzerland); Tomezzoli Anna (Verona University Hospital, Verona, Italy); Vieth Michael (Klinikum Bayreuth, Bayreuth, Germany); Wotherspoon Andrew (The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom); Zamboni Giuseppe (Sacro Cuore-Don Calabria Hospital, Negrar, Italy).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors. There was no need to get informed consent.
- 4.Henson DE, Dittus C, Younes M, Nguyen H, Albores-Saavedra J. Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973–2000: increase in the signet ring cell type. Arch Pathol Lab Med. 2004;128:765–70.Google Scholar
- 6.Lauwers GY, Carneiro F, Graham DY, Curado M-P, Franceschi S, Montgomery E, Tatematsu M, Hattori T: Gastric Carcinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system, 4th ed. IARC Press: Lyon; 2010, pp. 48–58.Google Scholar
- 17.Mandard AM, Dalibard F, Mandard JC, Marnay J, Henry-Amar M, Petiot JF, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathol Correlations Cancer. 1994;73:2680–6.Google Scholar
- 28.Carneiro, F. Classification of gastric carcinoma. Curr Diag Pathol. 2017;4:5.Google Scholar
- 29.Stelzner S, Emmrich P. The mixed type in Laurén’s classification of gastric carcinoma. Histologic description and biologic behavior. Gen Diagn Pathol. 1997;143:39–48.Google Scholar
- 37.Fujimoto A, Ishikawa Y, Ishii T, Yamada A, Igarashi Y, Ohmoto Y, et al. Differences between gastric signet-ring cell carcinoma and poorly differentiated adenocarcinoma: a comparison of histopathologic features determined by mucin core protein and trefoil factor family peptide immunohistochemistry. Pathol Int. 2017;67:398–403.CrossRefGoogle Scholar