1. 위암병리보고서의 기재사항
서울대학교
김 우 호

2. Stomach, subtotal gastrectomy
Advanced gastric carcinoma
- Histologic classification: signet ring cell carcinoma
- Gross type: Borrmann 3
- Location: middle third, anterior wall
- Lauren classification: diffuse type
- Size: 3.0 x 2.5 x 0.2 cm
- Depth of invasion: invade into subserosa (pT2b)
- Surgical margins: free from tumor
safety margins: proximal: 2.5 cm, distal: 4.0 cm
- Lymph node: metastasis in 1 out of 15 lymph nodes (pN1)
(#4,0/3; #5, 1/4, #6, 0/8)
- Angiolymphatic invasion: present, extramural, peritumoral
- Venous invasion: present, extramural, peritumoral
- Perineural invasion: not identified
- Tumor border (Ming’s classification): infiltrative
- Stromal reaction: desmoplasia

3. Three Categories
Essential (minimum)
Optional
Institute-specific

4. Histologic Classifications
WHO classification (4/7)
adenocarcinoma
papillary adenocarcinoma
tubular adenocarcinoma
mucinous adenocarcinoma
signet ring cell carcinoma
adenosquamous carcinoma
squamous cell carcinoma
small cell carcinoma
undifferentiated carcinoma
Japanese classification (1/7)
papillary adenocarcinoma
tubular adenocarcinoma, WD
tubular adenocarcinoma, MD
PD adenocaricinoma, solid
PD adenocarcinoma, non-solid
signet ring cell carcinoma
mucinous adenocarcinoma
others
adenosquamous carcinoma
squamous cell carcinoma
carcinoid tumor

5. Histologic Classifications
WHO classification
adenocarcinoma, NOS
papillary adenocarcinoma
tubular adenocarcinoma, WD
, MD
, PD
mucinous adenocarcinoma
signet ring cell carcinoma
adenosquamous carcinoma
squamous cell carcinoma
small cell carcinoma
undifferentiated carcinoma
hepatoid adenocarcinoma
Japanese classification
papillary adenocarcinoma
tubular adenocarcinoma, WD
tubular adenocarcinoma, MD
PD adenocarcinoma, solid
PD adenocarcinoma, non-solid
mucinous adenocarcinoma
signet ring cell carcinoma
adenosquamous carcinoma
squamous cell carcinoma
carcinoid tumor
others

7. Tumor Location TUMOR SITE (check all that apply) ___ Cardia ___ Fundus
*___ Anterior wall
*___ Posterior wall
___ Body
*___ Lesser curvature
*___ Greater curvature
___ Antrum

8. Essential or Optional Tumor size 12.5 x 5.5 x 1.2 cm
Surgical Margins: free from tumor
safety margins: proximal: 2.5 cm, distal: 4.0 cm

9. Essential or Optional Tumor size 12.5 x 5.5 x 1.2 cm
Surgical Margins: free from tumor
safety margins: proximal: 2.5 cm, distal: 4.0 cm

10. Depth of Invasion pTis: carcinoma in situ pT1a: invades mucosa
pT1b: invades submucosa
pT2a: invades muscularis propria
pT2b: invades subserosa
T3: penetrates serosa
T4: directly invades adjacent structure

11. Depth of Invasion pTis: carcinoma in situ pT1a: invades mucosa
invades lamina propria of mucosa
invades muscularis mucosa
pT1b: invades submucosa
invades less than one-third of submucosa
invades less than two-thirds of submucosa
invades more than two-thirds of submucosa
pT2a: invades muscularis propria
pT2b: invades subserosa
T3: penetrates serosa
T4: directly invades adjacent structure

12. Non-Essential Parameters
Stomach, subtotal gastrectomy
Advanced gastric carcinoma
- Histologic classification: signet ring cell carcinoma
- Gross type: Borrmann 3
1/7- Location: middle third, anterior wall
1/7- Lauren classification: diffuse type
- Size: 3.0 x 2.5 x 0.2 cm
- Depth of invasion: invade into subserosa (pT2b)
- Surgical margins: free from tumor
safety margins: proximal: 2.5 cm, distal: 4.0 cm
- Lymph node: metastasis in 1 out of 15 lymph nodes (pN1)
(#4,0/3; #5, 1/4, #6, 0/8)
1/7- Angiolymphatic invasion: present, extramural, peritumoral
1/7- Venous invasion: present, extramural, peritumoral
- Perineural invasion: not identified
3/7- Tumor border (Ming’s classification): infiltrative
4/7- Stromal reaction: desmoplasia

13. Invasion Lymphatic invasion (angiolymphatic invasion)
Present/not identified: CAP
(no/mild/severe): 영남
(no/minimal/moderate/marked) : 일본
Mural/extramural
Intratumoral/peritumoral

14. Additional Descriptions
Presence of precancerous lesion
Perforation
Mesenteric seeding
Metastatic disease in other sites
Separate lesion (GIST, polyp, adenoma)
Therapeutic response
Chronic gastritis
(metaplasia, atrophy, H. pylori, etc.)

15. Endoscopic Mucosal Resection (삼성서울병원)
육안 검색 : 판에 박아서 고정한 후, 다음 날 2 mm 간격으로 자른다.
Stomach, antrum, lesser curvature, mucosal resection:
Early gastric carcinoma, EGC type IIb+IIc,
Tubular adenocarcinoma, well differentiated, intestinal type
1) tumor size : x x mm
2) confined in lamina propria of mucosa
extension to muscularis mucosa
extension to submucosa (depth of infiltration: mm)
3) no endolymphatic tumor emboli
4) negative resection margins
(anterior: mm, posterior: mm, proximal: mm, distal: mm, deep: mm)

17. 종양이 두개 이상인 경우
(2/7): 한 개만 자세히 기록한다.
(5/7): 두 개 모두 자세히 기록한다.

18. Lymphatic/Vascular Invasion
(4/7) UICC: The microscopic presence of tumor cells in lymphatics or veins does not qualify as local spread in the T classification (except for liver and kidney). L or V symbol can be used to record such involvement.
(3/7) Japanese: In the classification of depth of invasion, tumor cells within veins and lymphatics are considered as well.

19. Example:
Depth of invasion: invades proper muscle layer (pT2a), (invasion
of subserosa by lymphatic invasion)

20. References AJCC/UICC Cancer Staging Manual (6th Ed) 2002
Japanese Classification of Gastric Carcinoma (First English Edition) 1995
CAP Surgical Pathology Cancer Case Summary (Checklist) January 2003
WHO Pathology and Genetics (tumor of the digestive system) 2000
위암기재사항을 위한 설명서. 대한위암학회 2002

21. The End

23. 1. Endoscopic mucosal resection : 삼성서울병원
육안 검색 : 판에 박아서 고정한 후, 다음 날 2 mm 간격으로 자른다.
Stomach, antrum, lesser curvature, mucosal resection :
. Early gastric carcinoma, EGC type IIb+IIc,
Tubular adenocarcinoma, well differentiated, intestinal type
1) tumor size : x cm
2) confined in lamina propria of mucosa
extension to muscularis mucosa
extension to submucosa (submucosa내의 침윤 깊이)
3) no endolymphatic tumor emboli
4) negative resection margins
(anterior: mm, posterior: mm, proximal: mm,
distal: mm, deep: mm)

24. Lymph Node Metastasis Metastasis in 5 out of 15 lymph nodes (pN1)
(#4,2/5; #5,2/2; #6,0/3; lesser curvature, 1/5)
No metastasis in 15 lymph nodes (pN0)
(#4,0/5; #5,0/7; #6,0/3)

25. Other Histologic Parameters
Lauren’s Classification
Intestinal
Diffuse
Mixed
Indeterminate
Ming’s Classification
Expanding
Infiltrative
Stromal reactions
Desmoplasia
Lymphocytic
Eosinophilia
Granulomatous

26. English 또는 한글 Stomach, subtotal gastrectomy Early gastric carcinoma
- Histologic class.: signet ring cell carcinoma
- Gross type: IIc
- Location: middle third, anterior wall
- Lauren classification: diffuse type
- Size: 3.0 x 2.5 x 0.2 cm
- Depth of invasion: submucosa1 (pT1b)
- Surgical margins: free from tumor
safety margins: proximal: 2.5, distal: 4.0 cm
- Lymph node: no metastasis in 15 LN
- Angiolymphatic invasion: not identified
- Venous invasion: not identified
- Perineural invasion: not identified
- Tumor border (Ming’s): infiltrative
- Stromal reaction: desmoplasia

28. Stomach, subtotal gastrectomy
Advanced gastric carcinoma
- Histologic classification: signet ring cell carcinoma
- Gross type: Borrmann 3
- Location: (a) middle third, (b) anterior wall
- Lauren classification: diffuse type
- Size: 3.0 x 2.5 x 0.2 cm
- Depth of invasion: invades into subserosa (pT2b)
- Surgical margins: free from tumor
safety margins: proximal: 2.5 cm, distal: 4.0 cm
- Lymph node: metastasis in 1 out of 15 lymph nodes
(#4,1/3; #5, 0/4, #6, 0/8)
- Angiolymphatic invasion: present, extramural, peritumoral
- Venous invasion: present, extramural, peritumoral
- Perineural invasion: not identified
- Tumor border (Ming’s classification): infiltrative
- Stromal reaction: desmoplasia
- Preexisting adenoma: not identified

29. Tumor Location
(a)
esophagus/upper third/middle third/lower third/ duodenum/entire length/unknown
(b)
lesser curvature/greater curvature/ anterior wall/ posterior wall/entire circumference/unknown