Korean J Gastroenterol.  2010 Oct;56(4):214-219. 10.4166/kjg.2010.56.4.214.

Pathology of Endoscopic Submucosal Dissection; How Do We Interpret?

• Kim KM
• Park CK

• KMID: 1718356
• DOI: http://doi.org/10.4166/kjg.2010.56.4.214

Abstract

It is widely accepted that endoscopic submucosal dissection (ESD) is an important treatment option for cases of early gastric carcinoma where the probability of lymph node metastasis is very low. The resected ESD specimens are carefully examined by serial sections at 2 mm intervals, and if pathology reveals submucosal invasion more than 500microm and/or lymphovascular invasion, or if the resection margin is involved by the tumor, surgery is recommended. In this point of view, thorough pathologic examination and reporting the accurate pathologic diagnosis of ESD specimen is very important. The diagnostic approach and pitfalls in the diagnosis of ESD specimen are reviewed.

Keyword

Gastric; Endoscopic submucosal dissection; Pathology

MeSH Terms

*Dissection
Embolism/pathology
Endoscopy, Gastrointestinal
Gastric Mucosa/*pathology/surgery
Humans
Lymphatic Metastasis/pathology
Stomach Neoplasms/*pathology/surgery

Figure

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  Fig. 1. Endoscopic submucosal dissection (ESD) specimen showing carcinoma within the proliferated muscularis mucosa (left; H&E, ×100). Photomicrograph of ESD specimen showed carcinoma cells invading into muscularis mucosa. As there was muscle below carcinoma cells, those two cases were diagnosed as intramucosal carcinoma (right; H&E, ×200).

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  Fig. 2. In this case, submucosal invasion of carcinoma was suspected (A; H&E, ×100). Immunohistochemical staining for desmin showed that carcinoma was con-fined in proliferating muscularis mucosa (B; immunohistochemical stain, ×100). This case was diagnosed as intramucosal adenocarcinoma.

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  Fig. 3. Adenocarcinoma showing invasion into submucosa (A; H&E, ×40). Negativity for desmin suggested periglandular desmoplastic re-action (B; immunohistochemical stain, ×200).

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  Fig. 4. Herniated gastric mucosa in the submucosa (A; H&E, ×200). Disappearance of muscularis mucosa in the area of herniation and remained muscularis mucosa be-neath herniated glands (B; immunohistochemical stain, ×200).

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  Fig. 5. Micropapillary carcinoma of the stomach found in ESD specimen (A; H&E, ×100). D2-40 immunohistochemistry showed proliferated lymphatics. Most of clear spaces were negative for D2-40 (B; immunohistochemical stain, ×200).

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  Fig. 6. Mapping of ESD specimen showed the involvement of anterior resection margin by type IIb early gastric carcinoma.

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