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Poorly differentiated gastric
adenocarcinoma of solid type is known to display clinicopathological diversity
and recently attracts attention as representative histological variant with
microsatellite instability which could be targeted by immune checkpoint
blockade with pembrolizumab and so on. However, its morphological
characteristics have rarely been investigated. In this study, we defined poorly
differentiated medullary carcinoma showing the following three features: (a)
more than 90% of the entire tumor were composed of poorly differentiated
adenocarcinoma in a medullary growth; (b) the tumor exhibited an expansive
growth at the tumor margin; and (c) special types such as a neuroendocrine
carcinoma, α-fetoprotein-producing carcinoma, and carcinoma with lymphoid
stroma were excluded. Based on the definition, we sub classified the poorly
differentiated gastric adenocarcinoma of solid type into the two groups:
medullary carcinoma and non-medullary carcinoma and clinicopathologically
evaluated 23 cases of medullary carcinomas and 38 cases of non-medullary
carcinomas. The medullary carcinomas less frequently displayed venous invasion,
lymphatic invasion, and lymph node metastasis, compared with the non-medullary
carcinoma (P=0.002, P<0.001 and P<0.001, respectively). The patients with
medullary carcinomas significantly showed better disease-free survival (P=0.017).
This is the first study to demonstrate that poorly differentiated
adenocarcinoma of solid type can be sub classified into tumors with low and
high malignant potentials. Gastric poorly differentiated medullary carcinoma is
considered to be a novel histological type predicting good patients’ prognosis.
Keywords: Gastric carcinoma, Poorly differentiated adenocarcinoma, Solid
type, Medullary carcinoma, Prognosis, Microsatellite instability
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