The Lauren classification of gastric carcinoma has prognostic and surgical implications. Which of the following correctly pairs the histological type with its characteristic spread pattern?
- A Intestinal type — diffuse infiltration of gastric wall (linitis plastica), metastasises to ovaries (Krukenberg tumour) more commonly
- B Diffuse type (signet-ring cells, poorly differentiated) — transcoelomic/peritoneal spread, Krukenberg tumour, and linitis plastica; worse prognosis ✓
- C Diffuse type — cohesive glands, haematogenous spread to liver more common, better prognosis
- D Intestinal type — predominantly affects younger patients, associated with H. pylori but not dietary factors
Correct answer: B. Diffuse type (signet-ring cells, poorly differentiated) — transcoelomic/peritoneal spread, Krukenberg tumour, and linitis plastica; worse prognosis
Explanation
Lauren's diffuse type is characterised by poorly cohesive cells (signet-ring cell carcinoma) that infiltrate the gastric wall diffusely, causing linitis plastica (leather bottle stomach). It spreads predominantly via peritoneum and can cause Krukenberg tumours (ovarian metastases) and Sister Mary Joseph nodule (umbilical metastasis). The intestinal type forms glandular structures, is more common in older males, associated with H. pylori and dietary carcinogens, and has a relatively better prognosis.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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