## Histological Classification of Gastric Carcinoma **Key Point:** The Lauren classification divides gastric adenocarcinoma into two main types: intestinal and diffuse, with prognostic and epidemiological differences. ### Diffuse Type (Linitis Plastica) **High-Yield:** The diffuse type is characterized by: - Infiltration of signet-ring cells throughout the gastric wall - Lack of a discrete mass; instead, diffuse thickening and rigidity - Poor prognosis due to advanced stage at presentation - Often associated with CDH1 gene mutations (hereditary diffuse gastric cancer) - Signet-ring cells are the hallmark — large vacuolated cells with eccentric nuclei **Clinical Pearl:** Linitis plastica ("leather bottle stomach") presents with dysphagia, early satiety, and weight loss due to loss of gastric compliance and capacity. ### Comparison Table: Lauren Classification | Feature | Intestinal Type | Diffuse Type | | --- | --- | --- | | **Cell morphology** | Columnar, mucin-producing | Signet-ring cells | | **Growth pattern** | Cohesive, glandular | Infiltrative, scattered | | **Gross appearance** | Ulcerated, fungating mass | Diffuse wall thickening | | **Prognosis** | Better (earlier detection possible) | Worse (advanced at diagnosis) | | **Associated with** | Intestinal metaplasia, H. pylori | CDH1 mutations, hereditary forms | | **Age of onset** | Older (>50 years) | Younger (can be <40 years) | **Mnemonic:** **DIFF** = **D**iffuse type has **I**nfiltrative **F**eatures and **F**amilial predisposition (CDH1) ### Why This Case Is Diffuse Type The presence of signet-ring cells on histology, combined with CT findings of diffuse gastric wall thickening (rather than a focal mass), and the patient's presentation with dysphagia and early satiety, all point to the diffuse type with linitis plastica pattern. [cite:Robbins 10e Ch 17]
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