Variable Endoscopic Findings and Clinicopathological Characteristics of Borrmann Type 4 Advanced Gastric Cancer

Chang, Ji Young; Shim, Ki Nam; Tae, Chung Hyun; Choe, A Reum; Moon, Chang Mo; Kim, Seong Eun; Jung, Hye Kyung; Jung, Sung Ae

doi:2015.15.3.166

Korean J Helicobacter Up Gastrointest Res > Volume 15(3); 2015 > Article

Original Article

The Korean Journal of Helicobacter and Upper Gastrointestinal Research 2015;15(3):166-173.
DOI: https://doi.org/10.7704/kjhugr.2015.15.3.166 Published online September 10, 2015.

Variable Endoscopic Findings and Clinicopathological Characteristics of Borrmann Type 4 Advanced Gastric Cancer

Ji Young Chang, Ki Nam Shim, Chung Hyun Tae, A Reum Choe, Chang Mo Moon, Seong Eun Kim, Hye Kyung Jung, Sung Ae Jung

Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea. shimkn@ewha.ac.kr

Borrmann 4형 위암의 다양한 내시경 소견과 임상적 특성

장지영, 심기남, 태정현, 최아름, 문창모, 김성은, 정혜경, 정성애

이화여자대학교 의학전문대학원 내과학교실, 의과학연구소

Abstract

BACKGROUND/AIMS
Borrmann type 4 advanced gastric cancer (AGC) is difficult to diagnose. There are no typical endoscopic findings. Endoscopic biopsies have a high false negative rate because Borrmann type 4 AGC frequently resides below the submucosal cells from which it develops. The aim of this study was to investigate the endoscopic findings of Borrmann type 4 AGC in order to improve diagnosis rates. MATERIALS AND METHODS: A total of 24 patients with pathologically proven Borrmann type 4 AGC at the Ewha Womans University Medical Center between January 2008 and May 2013 were included. We divided the cases according to their distinguishing endoscopic findings. The diagnostic yield for endoscopic biopsies was evaluated. RESULTS: The most common endoscopic findings were cases with Bormann type 4 AGC like lesions (diffuse infiltrative, n=10), followed by Bormann type 3 AGC like lesions (ulceroinfiltrative, n=9), Borrmann type 2 AGC like lesions (ulcerofungating, n=4) and early gastric cancer like lesion (n=1). Among the 23 cases in which endoscopic biopsies was performed, the diagnostic yield for the first endoscopic biopsy was 87.0% (n=20). All of the second endoscopic biopsies failed to diagnose the malignancy. CONCLUSIONS: The endoscopic findings of Borrmann type 4 AGC are atypical and diverse. In cases where negative results are accompanied by a malignant impression, further meticulous evaluation should be performed with careful targeting.

Key Words: Stomach neoplasms; Endoscopy, gastrointestinal