Three-dimensional morphology of gastric adenocarcinoma. Atypical glands as a basis for histopathologic diagnosis.

The basic architectural pattern of adenocarcinoma was established by 3-D reconstruction of carcinomatous glands and their lumina from serial histologic sections in four gastrectomy specimens to establish strict morphologic criteria of adenocarcinoma and related lesions on structural basis. The carcinomatous glands in the moderately differentiated type had multiple anastomoses with one another forming a 3-D network, a pattern quite different from the arborescent normal glands, whereas the lumina were separated into many small parts, giving the cell masses a porous character. Well differentiated tumor had more connections between lumina, giving rise to the formation of dense luminal network, while in the poorly differentiated variety the glands lost unity, broken up into fragmental nests. These analyses provided a new viewpoint from which to establish a basis for the discrimination of dysplastic from overtly malignant lesions.