Characteristics of submucosal gastric carcinoma with lymph node metastatic disease H J Son, S Y Song, 1 S Kim, 3 J H Noh, 2 T S Sohn, 2 D S Kim 1 & J C Rhee Departments of Medicine, 1 Pathology and 2 Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, and 3 Biostatics Unit, Centre for Clinical Research, Samsung Biomedical Research Institute, Seoul, Korea Date of submission 7 July 2004 Accepted for publication 4 August 2004 Son H J, Song S Y, Kim S, Noh J H, Sohn T S, Kim D S & Rhee J C (2005) Histopathology 46, 158–165 Characteristics of submucosal gastric carcinoma with lymph node metastatic disease Aim: To study the correlation between lymph node metastatic disease and various pathological parame- ters. Lymph node metastasis is the most important factor in determining the prognosis of patients with early gastric cancer and is significantly associated with the submucosal invasion of neoplastic cells. However, the depth of submucosal layer as well as the depth of submucosal tumour invasion varies among different cases. Methods and results: We studied various pathological parameters including the macroscopic appearance, location, size, area, differentiation, invasion depth, vascularity and fibrosis of submucosal gastric carcino- mas (SMGC), using 248 age- and sex-matched tissue samples. The presence of lymphatic emboli, a larger area, greater size, a non-flat gross type and an increased vascularity of the tumour were significantly associated with node-positive SMGC. Among the three depth-related parameters, the ocular scale measure- ment, the sm3 method and the sm2 method, only the ocular scale measurement showed a significant corre- lation with node-positive SMGC. Using multivariate analysis, the incidence of lymph node metastasis increased in the lymphatic tumour emboli and in the tumours that invaded more than half of the submuco- sal layer. Conclusions: These histological indicators seem to be a feasible and easy way to predict lymph node metastatic disease from limited surgery specimens. Pathologists should carefully investigate the lymphatic invasion of tumour cells and measure the invasion depth of the tumour. Keywords: neoplasm metastasis, pathology, stomach neoplasms Abbreviations: EGC, early gastric cancer; SMGC, submucosal gastric carcinoma Introduction Gastric cancer is the second most common cause of cancer deaths in the world and one of the most common cancers in east Asia and South America. Recent advances in diagnostic techniques and fully established education systems have increased the early detection of gastric carcinoma, especially in high incidence areas such as Korea and Japan. Early gastric carcinoma (EGC) is defined as a gastric carcinoma confined to the mucosa or submucosa regardless of the presence of lymph node status. Patients who undergo a resection for EGC have an excellent prognosis, with a 5-year survival rate of nearly 95%. 1–4 Many studies indicate that lymph node metastasis is the most important factor in determining the prognosis of patients with EGC, and that it is significantly associated with the submucosal invasion of neoplastic cells. 1–3,5–16 Most cases of lymph node metastatic disease in EGC patients are those in which cancers have invaded the submucosal layer. However, the depth of invasion into the submucosal layer and the depth or length of the submucosal layer varies between cases, even in normal or non-tumour cases. It has been a matter of controversy which method is best to Address for correspondence: Sang Yong Song MD, Department of Pathology, Samsung Medical Centre, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. e-mail: yodasong@smc.samsung.co.kr Ó 2005 Blackwell Publishing Limited. Histopathology 2005, 46, 158–165. DOI: 10.1111/j.1365-2559.2005.02049.x