Which histopathological feature best distinguishes intestinal-type gastric carcinoma from diffuse-type gastric carcinoma?

Question

Accepted Answer

A. Formation of glandular structures with intestinal metaplasia. ## Distinguishing Intestinal-Type from Diffuse-Type Gastric Carcinoma

### Histopathological Comparison

| Feature | Intestinal-Type | Diffuse-Type |
|---------|-----------------|---------------|
| **Growth pattern** | Cohesive, glandular structures | Scattered individual cells |
| **Cell morphology** | Columnar cells, mucin-producing | Signet-ring cells (mucin-filled) |
| **Mass formation** | Well-defined mass | Diffuse infiltration (linitis plastica) |
| **Associated metaplasia** | Intestinal metaplasia present | Absent or minimal |
| **Prognosis** | Better (earlier detection) | Worse (advanced at diagnosis) |
| **Lauren classification** | Intestinal type | Diffuse type |

### Key Distinguishing Feature

**Key Point:** The formation of **glandular structures with intestinal metaplasia** is the hallmark of intestinal-type gastric carcinoma. This arises from areas of chronic intestinal metaplasia (IM) in the gastric mucosa, following the Correa cascade: chronic gastritis → atrophy → intestinal metaplasia → dysplasia → carcinoma.

**High-Yield:** Intestinal-type carcinoma shows:
  - Organized glandular/tubular architecture
  - Mucin-secreting cells arranged in recognizable structures
  - Often associated with H. pylori infection and intestinal metaplasia
  - Better survival rates (more localized, detected earlier)

### Diffuse-Type Characteristics

**Clinical Pearl:** Diffuse-type carcinoma (signet-ring cell type) presents as:
  - Individual or small clusters of signet-ring cells infiltrating the gastric wall
  - No glandular formation
  - Linitis plastica (leather bottle stomach) appearance on imaging
  - Worse prognosis due to transmural infiltration and advanced stage at diagnosis

**Mnemonic:** **INT-GUT** = **INT**estinal-type has **GUT** (glandular) structures; **DIF-FUS** = **DIF**fuse-type is **FUS**ed (scattered) cells.

[cite:Robbins 10e Ch 17]

Answer

B. Diffuse infiltration without mass formation

Answer

C. Presence of signet-ring cells with mucin vacuoles

Answer

D. Poor prognosis and early lymph node involvement

Which histopathological feature best distinguishes intestinal-type gastric carcinoma from diffuse-type gastric carcinoma?

Explanation

Distinguishing Intestinal-Type from Diffuse-Type Gastric Carcinoma

Histopathological Comparison

Key Distinguishing Feature

Diffuse-Type Characteristics

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Feature	Intestinal-Type	Diffuse-Type
Growth pattern	Cohesive, glandular structures	Scattered individual cells
Cell morphology	Columnar cells, mucin-producing	Signet-ring cells (mucin-filled)
Mass formation	Well-defined mass	Diffuse infiltration (linitis plastica)
Associated metaplasia	Intestinal metaplasia present	Absent or minimal
Prognosis	Better (earlier detection)	Worse (advanced at diagnosis)
Lauren classification	Intestinal type	Diffuse type