## Histological Classification of Gastric Cancer **Key Point:** The intestinal type (Lauren classification) accounts for approximately 50–60% of gastric cancers globally and is the most common histological variant. ### Lauren Classification System | Type | Frequency | Characteristics | Prognosis | Association | |------|-----------|-----------------|-----------|-------------| | **Intestinal** | 50–60% | Well-differentiated, glandular, ulcerated | Better (relatively) | IM, H. pylori, age | | **Diffuse** | 30–40% | Poorly differentiated, signet ring cells, infiltrative | Worse | CDH1 mutation, young age | | **Mixed** | 10–15% | Features of both | Intermediate | Variable | **High-Yield:** Intestinal-type gastric cancer is associated with: - Chronic H. pylori infection - Intestinal metaplasia (IM) of the gastric mucosa - Older age at presentation - Better overall prognosis compared to diffuse type - More common in high-incidence regions (East Asia, Eastern Europe) **Clinical Pearl:** The intestinal type typically presents as an ulcerated or polypoid mass (as in this case), whereas diffuse type presents with linitis plastica ("leather bottle stomach") and is more aggressive. **Warning:** Do not confuse signet ring cell carcinoma (a morphological subtype that can occur in both intestinal and diffuse types) with the diffuse type itself. Signet ring cells are a feature, not a classification system. ### Pathogenesis Sequence (Intestinal Type) ```mermaid flowchart TD A[Normal gastric mucosa]:::outcome --> B[H. pylori infection]:::outcome B --> C[Chronic inflammation]:::outcome C --> D[Intestinal metaplasia]:::outcome D --> E[Dysplasia]:::outcome E --> F[Intestinal-type adenocarcinoma]:::urgent style F fill:#ff6b6b ``` **Mnemonic:** **HINT** — **H**. pylori, **I**ntestinal metaplasia, **N**ew dysplasia, **T**umor (intestinal type adenocarcinoma).
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.