PMC3015792_01
Genealogy demonstrating 4 generations of stomach cancer, 2 of which carried the CDH1 germline mutation, consistent with hereditary diffuse gastric cancer (HDGC). Thirteen patients had prophylactic gastrectomy, including the proband who underwent successful total laparoscopic gastrectomy. Eighteen patients were identified as having gastric cancer, and 11 of those were identified as carrying the CDH1 tumor suppressor gene mutation. Three patients were identified as carrying the CDH1 tumor suppressor gene mutation but did not have cancer.
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F1
Pedigree analysis of her family shows that the family has an inheritable gastric cancer that exhibits autosomal dominant transmission with high penetrance (Figure 1).
Diagram of patient in lithotomy position with location of surgeon, assistants, and placement of laparoscopic ports.
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F2
A total of 4 ports were used (three 5-mm ports and one 12-mm port) in addition to the hand port (Figure 2).
Adenocarcinoma in situ, showing neoplastic goblet cells within foveolar epithelium (as outlined by black arrows).
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F3
Only microscopic examination of the entire gastric mucosa revealed widespread adenocarcinoma in situ (Figure 3) and 11 foci of invasive adenocarcinoma limited to the lamina propria (Figures 4).
Focus of invasive adenocarcinoma, showing signet ring cells in the lamina propria distorting gastric glands (as outlined by black arrows).
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F4
Only microscopic examination of the entire gastric mucosa revealed widespread adenocarcinoma in situ (Figure 3) and 11 foci of invasive adenocarcinoma limited to the lamina propria (Figures 4).