Guessing the size. EndoTODAY

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[Gastric cancer 831. Guessing the size]

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Guessing the size is sometimes not easy. What is your guess in this case?

A GI fellow endoscopist guessed as a 5cm EGC.

Early gastric cancer IIa+IIc
- Location : angle
- Size : 5 cm
- Angle mucosal thickenig Ǹ ǥ hyperemic Ͽ angle ߾ nodular Ͽ . PW δ hematin پ ־ . 谡 Ҹ Ȯ Ͽ dye spray Ͽ , angle ü involve ϴ elevated lesion Ǹ LB LC involve Ǿ ־ (img 41).

After pre-operative clipping, subtotal gastrectomy was done. The final pathologic size was 6.5cm. It was a larger mucosal cancer with lymph node metastasis at station 7 (left gastric node).

Stomach, radical subtotal gastrectomy: Early gastric carcinoma
1. Location : middle third, Center at body and lesser curvature
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, well differentiated, >> tubular adenocarcinoma, poorly (solid) differentiated (20%)
4. Histologic type by Lauren : mixed
5. Size : 6.5x4.0 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 2.3 cm, distal 6.5 cm
8. Lymph node metastasis : metastasis to 1 out of 25 regional lymph nodes (pN1) (perinodal extension: present) (1/25: "3", 0/10; "4", 0/7; "5", 0/0; "6", 0/2; "7", 1/3; "9", 0/2; "8a", 0/1; "11p", 0/0; "12a", 0/0; "4sb", 0/0; "1", 0/0)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. Peritoneal cytology : negative
14. AJCC stage by 8th edition: pT1a N1

Hi! You did a good job.