Pathology of Early Gastric Cardiac Cancer

  • Qin Huang


Early gastric cardiac cancer occurs primarily in elderly populations, frequently as protruding lesions at upper endoscopy. Microscopically, well-moderately differentiated tubular and papillary adenocarcinomas are most common in this cancer but show a variety of growth patterns, which should be distinguished from reparative/reactive changes. The risk of nodal metastasis in early gastric cardiac carcinoma is significantly lower than that in distal gastric non-cardiac carcinoma, even for intramucosal poorly cohesive/signet-ring cell carcinoma. Because of considerable fibromuscular hyperplasia in the gastric cardia, distinction between invasion of early gastric cardiac carcinoma into the muscularis mucosae and invasion into the muscularis propria is critical because of different therapeutic management strategies.


Early gastric carcinoma Gastric cardiac carcinoma Stomach Cancer Lymph node metastasis 


  1. 1.
    Lauwers GY, Carneiro F, Graham DY, et al. Gastric carcinoma. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. WHO classification of tumours of the digestive system. Lyon: IARC Press; 2010. p. 48–58.Google Scholar
  2. 2.
    Tajima Y, Nakanishi Y, Yoshino T, et al. Clinicopathologic study of early adenocarcinoma of the gastric cardia: comparison with early adenocarcinoma of the distal stomach and esophagus. Oncology. 2001;61:1–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Huang Q, Fang C, Shi J, et al. Differences in clinicopathology of early gastric carcinoma between proximal and distal location in 438 Chinese patients. Sci Rep. 2015;5:13439. Scholar
  4. 4.
    Huang Q, Shi J, Sun Q, et al. Clinicopathologic characterization of small (≤ 2 cm) proximal and distal gastric carcinomas in a Chinese population. Pathology. 2015;47:526–32.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Cestari R, Villanacci V, Bassotti G, et al. The pathology of gastric cardia: a prospective, endoscopic, and morphologic study. Am J Surg Pathol. 2007;31(5):706–10.CrossRefPubMedGoogle Scholar
  6. 6.
    Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161–81.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Reis CA, David L, Correa P, et al. Intestinal metaplasia of human stomach displays distinct patterns of mucin (MUC1, MUC2, MUC5AC, and MUC6) expression. Cancer Res. 1999;59(5):1003–7.PubMedGoogle Scholar
  8. 8.
    Abadir A, Streutker C, Brezden-Masley C, Grin A, Kim YI. Intestinal metaplasia and the risk of gastric cancer in an immigrant Asian population. Clin Med Insights Gastroenterol. 2012;5:43–50.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Aida J, Vieth M, Shepherd NA, et al. Is carcinoma in columnar-lined esophagus always located adjacent to intestinal metaplasia?: a histopathologic assessment. Am J Surg Pathol. 2015;39(2):188–96.CrossRefPubMedGoogle Scholar
  10. 10.
    Huang Q, Fan X, Agoston AT, et al. Comparison of gastro-oesophageal junction carcinomas in Chinese versus American patients. Histopathology. 2011;59(2):188–97.CrossRefPubMedGoogle Scholar
  11. 11.
    Al-Haddad S, Chang AC, De Hertogh G, et al. Adenocarcinoma at the gastroesophageal junction. Ann N Y Acad Sci. 2014;1325:211–25.CrossRefPubMedGoogle Scholar
  12. 12.
    El-Zimaity HM, Ramchatesingh J, Saeed MA, Graham DY. Gastric intestinal metaplasia: subtypes and natural history. J Clin Pathol. 2001;54(9):679–83.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Schneider NI, Plieschnegger W, Geppert M, et al. Pancreatic acinar cells—a normal finding at the gastroesophageal junction? Data from a prospective Central European multicenter study. Virchows Arch. 2013;463(5):643–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Rugge M, Correa P, Dixon MF, et al. Gastric dysplasia: the Padova international classification. Am J Surg Pathol. 2000;24(2):167–76.CrossRefPubMedGoogle Scholar
  15. 15.
    Schlemper RJ, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut. 2000;47:251–5.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Schlemper RJ, Kato Y, Stolte M. Review of histological classifications of gastrointestinal epithelial neoplasia: differences in diagnosis of early carcinomas between Japanese and Western pathologists. J Gastroenterol. 2001;36(7):445–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Park DY, Srivastava A, Kim GH, et al. Adenomatous and foveolar gastric dysplasia: distinct patterns of mucin expression and background intestinal metaplasia. Am J Surg Pathol. 2008;32(4):524–33.CrossRefPubMedGoogle Scholar
  18. 18.
    Park DY, Srivastava A, Kim GH, et al. CDX2 expression in the intestinal-type gastric epithelial neoplasia: frequency and significance. Mod Pathol. 2010;23(1):54–61.CrossRefPubMedGoogle Scholar
  19. 19.
    Lee SE, Kang SY, Cho J, et al. Pyloric gland adenoma in Lynch syndrome. Am J Surg Pathol. 2014;38(6):784–92.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Cameron AJ, Carpenter HA. Barrett’s esophagus, high-grade dysplasia, and early adenocarcinoma: a pathological study. Am J Gastroenterol. 1997;92(4):586–91.PubMedGoogle Scholar
  21. 21.
    Zhang XQ, Huang Q, Goyal K, Odze R. DNA Ploidy Abnormalities in basal and superficial regions of the crypts in Barrett’s esophagus and associated neoplastic lesions. Am J Surg Pathol. 2008;32(9):1327–35.CrossRefPubMedGoogle Scholar
  22. 22.
    Kim A, Ahn SJ, Park DY, et al. Gastric crypt dysplasia: a distinct subtype of gastric dysplasia with characteristic endoscopic features and immunophenotypic and biological anomalies. Histopathology. 2016;68(6):843–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31–49.CrossRefPubMedGoogle Scholar
  24. 24.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRefGoogle Scholar
  25. 25.
    Yu HP, Fang C, Chen L, et al. Worse prognosis in papillary, compared to tubular, early gastric carcinoma. J Cancer. 2017;8(1):117–23.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Yasuda K, Adachi Y, Shiraishi N, Maeo S, Kitano S. Papillary adenocarcinoma of the stomach. Gastric Cancer. 2000;3:33–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Lee HJ, Kim GH, Park DY, et al. Is endoscopic submucosal dissection safe for papillary adenocarcinoma of the stomach? World J Gastroenterol. 2015;21:3944–52.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Fang C, Shi J, Sun Q, et al. Risk factors of lymph node metastasis in early gastric carcinomas diagnosed with WHO criteria in 379 Chinese patients. J Dig Dis. 2016;17(8):526–37.CrossRefPubMedGoogle Scholar
  29. 29.
    Roh JH, Srivastava A, Lauwers GY, et al. Micropapillary carcinoma of stomach: a clinicopathologic and immunohistochemical study of 11 cases. Am J Surg Pathol. 2010;34(8):1139–46.CrossRefPubMedGoogle Scholar
  30. 30.
    Hattori T, Sentani K, Hattori Y, Oue N, Yasui W. Pure invasive micropapillary carcinoma of the esophagogastric junction with lymph nodes and liver metastasis. Pathol Int. 2016;66(10):583–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Wang X, Ouyang H, Yamamoto Y, et al. Residual embryonic cells as precursors of a Barrett’s-like metaplasia. Cell. 2011;145(7):1023–35.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY. Analysis of 151 consecutive gastric submucosal tumors according to tumor location. J Surg Oncol. 2011;104(1):72–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Abraham SC, Krasinskas AM, Hofstetter WL, Swisher SG, Wu TT. “Seedling” mesenchymal tumors (gastrointestinal stromal tumors and leiomyomas) are common incidental tumors of the esophagogastric junction. Am J Surg Pathol. 2007;31(11):1629–35.CrossRefPubMedGoogle Scholar
  34. 34.
    Min YW, Park HN, Min BH, Choi D, Kim KM, Kim S. Preoperative predictive factors for gastrointestinal stromal tumors: analysis of 375 surgically resected gastric subepithelial tumors. J Gastrointest Surg. 2015;19(4):631–8.CrossRefPubMedGoogle Scholar
  35. 35.
    Idema DL, Daryanani D, Sterk LM, Klaase JM. Collision tumor of the stomach: a case of an adenocarcinoma and a gastrointestinal stromal tumor. Case Rep Gastroenterol. 2008;2(3):456–60.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Grin A, Streutker CJ. Neuroendocrine tumors of the luminal gastrointestinal tract. Arch Pathol Lab Med. 2015;139:750–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Melton SD, Genta RM. Gastric cardiac polyps: a clinicopathologic study of 330 cases. Am J Surg Pathol. 2010;34(12):1792–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Zbuk KM, Eng C. Hamartomatous polyposis syndromes. Nat Clin Pract Gastroenterol Hepatol. 2007;4:492–502.CrossRefPubMedGoogle Scholar
  39. 39.
    Howe JR, Mitros FA, Summers RW. The risk of gastrointestinal carcinoma in familial juvenile polyposis. Ann Surg Oncol. 1998;5:751–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Burmester JK, Bell LN, Cross D, Meyer P, Yale SH. A SMAD4 mutation indicative of juvenile polyposis syndrome in a family previously diagnosed with Menetrier’s disease. Dig Liver Dis. 2016;48(10):1255–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Lunca S, Porumb V, Velenciuc N, Ferariu D, Dimofte G. Giant solitary gastric Peutz-Jeghers polyp mimicking a malignant gastric tumor: the largest described in literature. J Gastrointestin Liver Dis. 2014;23(3):321–4.PubMedGoogle Scholar
  42. 42.
    Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology. 2000;119:1447–53.CrossRefPubMedGoogle Scholar
  43. 43.
    Shaco-Levy R, Jasperson KW, Martin K, et al. Morphologic characterization of hamartomatous gastrointestinal polyps in Cowden syndrome, Peutz-Jeghers syndrome, and juvenile polyposis syndrome. Hum Pathol. 2016;49:39–48.CrossRefPubMedGoogle Scholar
  44. 44.
    Wood LD, Noë M, Hackeng W, et al. Patients with McCune-Albright syndrome have a broad spectrum of abnormalities in the gastrointestinal tract and pancreas. Virchows Arch. 2017;470(4):391–400.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Franzin G, Novelli P. Gastritis cystica profunda. Histopathology. 1981;5:535–47.CrossRefPubMedGoogle Scholar
  46. 46.
    Lee HJ, Lee TH, Lee JU, et al. Clinical features of gastritis cystica profunda in patients without history of gastric surgery. Gastric cancer patients vs. non-cancerous patients. Korean J Med. 2006;71:511–7.Google Scholar
  47. 47.
    Xu G, Peng C, Li X, et al. Endoscopic resection of gastritis cystica profunda: preliminary experience with 34 patients from a single center in China. Gastrointest Endosc. 2015;81(6):1493–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Choi MG, Jeong JY, Kim KM, et al. Clinical significance of gastritis cystica profunda and its association with Epstein-Barr virus in gastric cancer. Cancer. 2012;118(21):5227–33.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Qin Huang
    • 1
    • 2
  1. 1.Pathology and Laboratory MedicineVeterans Affairs Boston Healthcare SystemWest RoxburyUSA
  2. 2.Harvard Medical School and Brigham and Women’s HospitalBostonUSA

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