The patient underwent partial gastrectomy.
Distal gastrectomy: A subtotal distal gastrectomy, received opened. Greater curve 110mm in length, lesser curve 45mm in length with attached omentum up to 320mm.Proximal margin inked blue, distal margin inked green and circumferential margin/serosa inked black. 18mm from the proximal margin and 30mm from the distal margin is a poorly demarcated ulcerated firm tan tumour with rolled edges 40x32mm. The tumour invades through muscularis propria into the perigastric tissue to a depth of 10mm. The tumour is 3mm from the circumferential resection margin and serosa underlying the tumour is roughened and puckered. Adjacent to the tumour is a poorly defined patch where the mucosa is roughened and dark brown 50x45mm. The remaining mucosa appears unremarkable. Within the fat are multiple rubbery ovoid lymph nodes up to 10mm. Fat placed into Carnoy's.
MICROSCOPIC DESCRIPTION:
The sections of stomach show invasive poorly differentiated adenocarcinoma of intestinal type. This arises in the floor of an ulcer involving transitional zone and antral mucosa. Tumour consists of poorly formed glandular structures lined by a stratified arrangement of cuboidal and columnar epithelial cells. These show moderate nuclear pleomorphism. Frequent mitotic figures are identified. Tumour extends through the full thickness of the muscularis propria into immediately adjacent omental adipose tissue to 1mm from the omental free serosal surface. No evidence of vascular, lymphatic or perineural invasion is seen. Immediately adjacent gastric mucosa shows moderate regenerative and inflammatory atypia with both acute and chronic inflammatory cells noted within the lamina propria. H. pylori are not identified. Sections from themacroscopically noted brown roughened mucosal area show full thickness benign mucosal ulceration. The distal margin passes through antral mucosa and is clear of tumour. The proximal margin passes through gastric body type mucosa and is also clear of tumour. The free serosal surface of stomach and the radial resection margin through gastric omentum are clear of tumour. No evidence of metastatic tumour is seen in any of 12 lymph nodes.