A 60-year-old Japanese man presents with early satiety and weight loss. Upper GI endoscopy reveals a large ulcerated lesion in the antrum. Biopsy shows mucin-secreting signet ring cells individually infiltrating the gastric wall without gland formation. This histological type is associated with:
- A H. pylori-induced intestinal metaplasia
- B E-cadherin (CDH1) germline mutation ✓
- C EBV infection of gastric epithelium
- D Autoimmune gastritis with hypergastrinemia
Correct answer: B. E-cadherin (CDH1) germline mutation
Explanation
The diffuse type of gastric carcinoma, characterized by signet ring cells infiltrating as single cells (linitis plastica pattern), is associated with germline E-cadherin (CDH1) mutations in hereditary diffuse gastric cancer syndrome. Loss of E-cadherin impairs cell-to-cell adhesion, allowing tumor cells to infiltrate without forming cohesive glands. This contrasts with the intestinal type of gastric carcinoma, which is strongly associated with H. pylori, intestinal metaplasia, and dietary factors, following the Correa cascade.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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