위암병리보고서의 기재사항 서울대학교 김 우 호

Stomach, subtotal gastrectomy Advanced gastric carcinoma - Histologic classification: signet ring cell carcinoma - Gross type: Borrmann 3 - Location: middle third, anterior wall - Lauren classification: diffuse type - Size: 3.0 x 2.5 x 0.2 cm - Depth of invasion: invade into subserosa (pT2b) - Surgical margins: free from tumor safety margins: proximal: 2.5 cm, distal: 4.0 cm - Lymph node: metastasis in 1 out of 15 lymph nodes (pN1) (#4,0/3; #5, 1/4, #6, 0/8) - Angiolymphatic invasion: present, extramural, peritumoral - Venous invasion: present, extramural, peritumoral - Perineural invasion: not identified - Tumor border (Ming’s classification): infiltrative - Stromal reaction: desmoplasia

Three Categories Essential (minimum) Optional Institute-specific

Histologic Classifications WHO classification (4/7) adenocarcinoma papillary adenocarcinoma tubular adenocarcinoma mucinous adenocarcinoma signet ring cell carcinoma adenosquamous carcinoma squamous cell carcinoma small cell carcinoma undifferentiated carcinoma Japanese classification (1/7) papillary adenocarcinoma tubular adenocarcinoma, WD tubular adenocarcinoma, MD PD adenocaricinoma, solid PD adenocarcinoma, non-solid signet ring cell carcinoma mucinous adenocarcinoma others adenosquamous carcinoma squamous cell carcinoma carcinoid tumor

Histologic Classifications WHO classification adenocarcinoma, NOS papillary adenocarcinoma tubular adenocarcinoma, WD , MD , PD mucinous adenocarcinoma signet ring cell carcinoma adenosquamous carcinoma squamous cell carcinoma small cell carcinoma undifferentiated carcinoma hepatoid adenocarcinoma Japanese classification papillary adenocarcinoma tubular adenocarcinoma, WD tubular adenocarcinoma, MD PD adenocarcinoma, solid PD adenocarcinoma, non-solid mucinous adenocarcinoma signet ring cell carcinoma adenosquamous carcinoma squamous cell carcinoma carcinoid tumor others

Tumor Location TUMOR SITE (check all that apply) ___ Cardia ___ Fundus *___ Anterior wall *___ Posterior wall ___ Body *___ Lesser curvature *___ Greater curvature ___ Antrum

Essential or Optional Tumor size 12.5 x 5.5 x 1.2 cm Surgical Margins: free from tumor safety margins: proximal: 2.5 cm, distal: 4.0 cm

Essential or Optional Tumor size 12.5 x 5.5 x 1.2 cm Surgical Margins: free from tumor safety margins: proximal: 2.5 cm, distal: 4.0 cm

Depth of Invasion pTis: carcinoma in situ pT1a: invades mucosa pT1b: invades submucosa pT2a: invades muscularis propria pT2b: invades subserosa T3: penetrates serosa T4: directly invades adjacent structure

Depth of Invasion pTis: carcinoma in situ pT1a: invades mucosa invades lamina propria of mucosa invades muscularis mucosa pT1b: invades submucosa invades less than one-third of submucosa invades less than two-thirds of submucosa invades more than two-thirds of submucosa pT2a: invades muscularis propria pT2b: invades subserosa T3: penetrates serosa T4: directly invades adjacent structure

Non-Essential Parameters Stomach, subtotal gastrectomy Advanced gastric carcinoma - Histologic classification: signet ring cell carcinoma - Gross type: Borrmann 3 1/7- Location: middle third, anterior wall 1/7- Lauren classification: diffuse type - Size: 3.0 x 2.5 x 0.2 cm - Depth of invasion: invade into subserosa (pT2b) - Surgical margins: free from tumor safety margins: proximal: 2.5 cm, distal: 4.0 cm - Lymph node: metastasis in 1 out of 15 lymph nodes (pN1) (#4,0/3; #5, 1/4, #6, 0/8) 1/7- Angiolymphatic invasion: present, extramural, peritumoral 1/7- Venous invasion: present, extramural, peritumoral - Perineural invasion: not identified 3/7- Tumor border (Ming’s classification): infiltrative 4/7- Stromal reaction: desmoplasia

Invasion Lymphatic invasion (angiolymphatic invasion) Present/not identified: CAP (no/mild/severe): 영남 (no/minimal/moderate/marked) : 일본 Mural/extramural Intratumoral/peritumoral

Additional Descriptions Presence of precancerous lesion Perforation Mesenteric seeding Metastatic disease in other sites Separate lesion (GIST, polyp, adenoma) Therapeutic response Chronic gastritis (metaplasia, atrophy, H. pylori, etc.)

Endoscopic Mucosal Resection (삼성서울병원) 육안 검색 : 판에 박아서 고정한 후, 다음 날 2 mm 간격으로 자른다. Stomach, antrum, lesser curvature, mucosal resection: Early gastric carcinoma, EGC type IIb+IIc, Tubular adenocarcinoma, well differentiated, intestinal type 1) tumor size : x x mm 2) confined in lamina propria of mucosa extension to muscularis mucosa extension to submucosa (depth of infiltration: mm) 3) no endolymphatic tumor emboli 4) negative resection margins (anterior: mm, posterior: mm, proximal: mm, distal: mm, deep: mm)

종양이 두개 이상인 경우 (2/7): 한 개만 자세히 기록한다. (5/7): 두 개 모두 자세히 기록한다.

Lymphatic/Vascular Invasion (4/7) UICC: The microscopic presence of tumor cells in lymphatics or veins does not qualify as local spread in the T classification (except for liver and kidney). L or V symbol can be used to record such involvement. (3/7) Japanese: In the classification of depth of invasion, tumor cells within veins and lymphatics are considered as well.

Example: Depth of invasion: invades proper muscle layer (pT2a), (invasion of subserosa by lymphatic invasion)

References AJCC/UICC Cancer Staging Manual (6th Ed) 2002 Japanese Classification of Gastric Carcinoma (First English Edition) 1995 CAP Surgical Pathology Cancer Case Summary (Checklist) January 2003 WHO Pathology and Genetics (tumor of the digestive system) 2000 위암기재사항을 위한 설명서. 대한위암학회 2002

The End

1. Endoscopic mucosal resection : 삼성서울병원 육안 검색 : 판에 박아서 고정한 후, 다음 날 2 mm 간격으로 자른다. Stomach, antrum, lesser curvature, mucosal resection : . Early gastric carcinoma, EGC type IIb+IIc, Tubular adenocarcinoma, well differentiated, intestinal type 1) tumor size : x cm 2) confined in lamina propria of mucosa extension to muscularis mucosa extension to submucosa (submucosa내의 침윤 깊이) 3) no endolymphatic tumor emboli 4) negative resection margins (anterior: mm, posterior: mm, proximal: mm, distal: mm, deep: mm)

Lymph Node Metastasis Metastasis in 5 out of 15 lymph nodes (pN1) (#4,2/5; #5,2/2; #6,0/3; lesser curvature, 1/5) No metastasis in 15 lymph nodes (pN0) (#4,0/5; #5,0/7; #6,0/3)

Other Histologic Parameters Lauren’s Classification Intestinal Diffuse Mixed Indeterminate Ming’s Classification Expanding Infiltrative Stromal reactions Desmoplasia Lymphocytic Eosinophilia Granulomatous

English 또는 한글 Stomach, subtotal gastrectomy Early gastric carcinoma - Histologic class.: signet ring cell carcinoma - Gross type: IIc - Location: middle third, anterior wall - Lauren classification: diffuse type - Size: 3.0 x 2.5 x 0.2 cm - Depth of invasion: submucosa1 (pT1b) - Surgical margins: free from tumor safety margins: proximal: 2.5, distal: 4.0 cm - Lymph node: no metastasis in 15 LN - Angiolymphatic invasion: not identified - Venous invasion: not identified - Perineural invasion: not identified - Tumor border (Ming’s): infiltrative - Stromal reaction: desmoplasia

Stomach, subtotal gastrectomy Advanced gastric carcinoma - Histologic classification: signet ring cell carcinoma - Gross type: Borrmann 3 - Location: (a) middle third, (b) anterior wall - Lauren classification: diffuse type - Size: 3.0 x 2.5 x 0.2 cm - Depth of invasion: invades into subserosa (pT2b) - Surgical margins: free from tumor safety margins: proximal: 2.5 cm, distal: 4.0 cm - Lymph node: metastasis in 1 out of 15 lymph nodes (#4,1/3; #5, 0/4, #6, 0/8) - Angiolymphatic invasion: present, extramural, peritumoral - Venous invasion: present, extramural, peritumoral - Perineural invasion: not identified - Tumor border (Ming’s classification): infiltrative - Stromal reaction: desmoplasia - Preexisting adenoma: not identified

Tumor Location (a) esophagus/upper third/middle third/lower third/ duodenum/entire length/unknown (b) lesser curvature/greater curvature/ anterior wall/ posterior wall/entire circumference/unknown