title: Pathological diagnosis is maybe non-essential for special gastric cancer: case reports and review.
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 6(th) 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.
authors.affiliation: Department of Gastrointestinal and Pancreatic Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
authors.forename: Wu
authors.initials: W
authors.lastname: Song
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Xu
authors.forename: Jin-Ning
authors.initials: JN
authors.lastname: Ye
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Chuang-Qi
authors.initials: CQ
authors.lastname: Chen
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Zhang
authors.forename: Shi-Rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Wen-Hua
authors.initials: WH
authors.lastname: Zhan
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: He
mesh_terms: D001706:Biopsy; D017024:Chemotherapy, Adjuvant; D003937:Diagnosis, Differential; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome
keywords: Borrmann type; Diagnosis; Gastric cancer; Pathology