The Lauren classification of gastric carcinoma divides tumours into intestinal and diffuse types. Which of the following statements correctly distinguishes the two types?

• A The intestinal type arises from normal gastric mucosa without H. pylori association, while the diffuse type is strongly H. pylori-associated
• B The intestinal type forms cohesive glandular structures, is associated with intestinal metaplasia and H. pylori, and has a better prognosis; the diffuse type (signet-ring cell) infiltrates without gland formation, has worse prognosis, and spreads as linitis plastica ✓
• C The diffuse type is predominantly located in the antrum, while the intestinal type is located in the cardia
• D Both types have identical survival rates when stage-matched

Explanation

Lauren classification: the intestinal type is well-differentiated, forms glandular structures, is associated with H. pylori, atrophic gastritis, and intestinal metaplasia (the Correa cascade), and has a relatively better prognosis. It is more common in high-incidence regions (East Asia). The diffuse type contains poorly cohesive signet-ring cells, lacks gland formation, infiltrates the gastric wall causing linitis plastica (leather bottle stomach), has a worse prognosis, and is more common in younger patients with CDH1 mutations. The diffuse type is NOT predominantly antral; it is more diffuse. H. pylori is associated with both types but the Correa cascade specifically produces the intestinal type.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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