Clinical and histological characteristics of gastric "crawling-type" adenocarcinoma.

BACKGROUND

Crawling-type adenocarcinoma (CTA) is an uncommon and poorly characterised subtype of early gastric cancer, primarily reported in isolated case and series studies.

AIMS: To investigate the clinicopathological and endoscopic features of CTA.

METHODS

We retrospectively analysed 17 patients with histologically confirmed CTA. Clinical characteristics, endoscopic findings, including magnifying endoscopy with narrow-band imaging (ME-NBI) and computed tomography (CT) imaging, were evaluated. Histological features were assessed using hematoxylin-eosin (H&E) staining, and immunohistochemistry was performed to study the clinical features.

RESULT: The mean age was 68.7 years; 64.7 % were male. Most patients were asymptomatic. Endoscopically, CTA appeared as flat or slightly elevated lesions with indistinct margins and brownish discolouration. ME-NBI revealed dilated, tortuous microvessels and mild microsurface irregularity, while CT showed no metastasis. Histologically, 82.4 % of tumors were confined to the mucosa, consisting of moderately differentiated tubular glands with horizontal spread, mild to moderate atypia, and preserved polarity. Characteristic "shaking-hand" or "WHY × " patterns were observed. Immunohistochemically, cytokeratin was positive in all cases. MUC5AC and MUC6 were aberrantly expressed in 70.6 % of cases, and most showed p53 overexpression.

CONCLUSION

CTA is a histologically indolent but diagnostically challenging subtype of early gastric cancer. Recognition of its endoscopic and pathological features is essential for accurate diagnosis and management.