Case Report
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World J Gastroenterol. Jun 28, 2013; 19(24): 3904-3910
Published online Jun 28, 2013. doi: 10.3748/wjg.v19.i24.3904
Pathological diagnosis is maybe non-essential for special gastric cancer: Case reports and review
Wu Song, Chun-Yu Chen, Jian-Bo Xu, Jin-Ning Ye, Liang Wang, Chuang-Qi Chen, Xin-Hua Zhang, Shi-Rong Cai, Wen-Hua Zhan, Yu-Long He
Wu Song, Chun-Yu Chen, Jian-Bo Xu, Jin-Ning Ye, Liang Wang, Chuang-Qi Chen, Xin-Hua Zhang, Shi-Rong Cai, Wen-Hua Zhan, Yu-Long He, Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
Author contributions: Song W and Chen CY contributed equally to this work; Xu JB, Ye JN, Wang L, Chen CQ, Zhang XH, Cai SR, Zhan WH and He YL gave valuable advice on multidisciplinary discussion team discussion and designed the report; Song W and Chen CY drafted the manuscript.
Supported by The Science and Technology Development Project of Guangdong Province, No. 2011B031800240 and No. 2012B031800389
Correspondence to: Yu-Long He, MD, Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhongshan Er Road, Guangzhou 510080, Guangdong Province, China. ylh@medmail.com.cn
Telephone: +86-20-28823389 Fax: +86-20-28823389
Received: November 21, 2012
Revised: April 17, 2013
Accepted: May 8, 2013
Published online: June 28, 2013
Abstract

Histopathological results are critical for the diagnosis and surgical decision regarding gastric cancer. However, opposite opinions from radiology and pathology can sometimes affect clinical decisions. The two cases reported in this article were both highly suspected as gastric cancer by clinical manifestations and radiologic findings, although both showed negative results in the first biopsy examination. One was confirmed as gastric cancer by the time of the 6th biopsy, while the other was still negative even after 8 biopsies. With a definite pathologic result and the agreement of the patient for the latter case, both of them finally received surgery. Postoperative pathological examination revealed findings that were the same as Borrmann type IV gastric cancer. We believed that duplicate biopsies under radiologic guidance were necessary for highly suspected gastric cancer cases in the absence of a definite pathology result, and patients should be under close follow-up. We propose that, if gastric cancer is highly suspected when typical radiology changes of widely diffuse gastric parietal lesions suffice to exclude lymphoma and other similar situations, and even in absence of a positive biopsy result, a diagnostic laparotomy under laparoscopy and even radical gastrectomy may be reasonably performed by an experienced gastric cancer center with the agreement of the patient after being decided by a multidisciplinary discussion team.

Keywords: Gastric cancer, Pathology, Diagnosis, Borrmann type

Core tip: Histopathological diagnosis is the diagnostic gold standard of gastric cancer required by medical ethics and practice guideline. However, cases with repeated suspected false negative pathological results always concern medical practitioners a great deal. This article might illustrate a possible standard process for these cases. We propose that, if gastric cancer is highly suspected when typical radiology changes of widely diffuse gastric parietal lesions suffice to exclude lymphoma and other similar situations, and even in absence of a positive biopsy result, surgery could be perform with the agreement of the patient after being decided by a multidisciplinary discussion team.