Clinical Characteristics and Pathological Features of "Crawling-type" Early Gastric Carcinoma: A Retrospective Series of Eight Cases.

Background: "Crawling-type" early gastric carcinoma (EGC) is a rare subtype of gastric cancer (GC) that is challenging to diagnose at an early stage due to its low-grade nuclear heterogeneity and morphology that mimics intestinal metaplasia. This study aimed to explore the clinical characteristics and pathological features of patients with crawling-type EGC.

Methods: This case series study retrospectively included patients with crawling-type EGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy at the East Hospital Affiliated to Tongji University between January 2019 and March 2022.

Results: 8 patients (mean age 63.5 ± 7.8 years) were included: 4 underwent ESD, and 4 underwent partial gastrectomy. In 4 patients, the tumors were primarily located in the gastric cardia and the basal gland area of the upper stomach, while the other 4 patients had tumors in the antral region. Preoperative gastroscopy revealed atrophic gastritis and intestinal metaplasia in all patients. The lesions were generally flat in morphology. Submucosal infiltration was found in only one case. Signet ring cells were present in the tumors of 5 patients. The mucinous type was observed in 7 patients. Seven tumors were of the gastrointestinal mixed type. Curative resection was achieved in all patients. No recurrence events were observed in any patient at 1 year after surgery.

Conclusions: The crawling-type EGC may exhibit distinct clinical characteristics and pathological features compared with classical GC. Curative resection was achieved in all patients. The short-term prognosis of surgical treatment may be favorable.