Lymphatic metastasis
Malignant tumors of the stomach predominantly spread via the lymphatic route. The movement of tumor cells through lymphatic vessels can occur in two directions: orthograde (coinciding with the natural lymph flow) and retrograde (in the opposite direction).
Regional lymph nodes are the first to encounter the tumor. Located along the lesser and greater curvatures of the stomach, they bear the initial impact during orthograde metastasis.
Distant retrograde seeding holds special diagnostic significance in pathomorphology. Its detection often serves as the key to establishing a diagnosis:
- Virchow's metastasis — involvement of the left supraclavicular lymph node.
- Krukenberg tumor — specific metastatic involvement of the ovaries.
- Schnitzler's metastasis — proliferation of tumor cells in the pararectal tissue.
Hematogenous and implantation pathways
In addition to the lymphatic system, gastric cancer actively utilizes the bloodstream. Hematogenous metastasis leads to the formation of secondary tumor foci in distant organs. The liver is the most common target, reached via vessels of the hepatogastric ligament. Hematogenous seeding is also detected in bone tissue, brain structures, and skin.
The third route is implantation, or contact spread. It occurs when the tumor extends beyond the organ wall. Tumor cells disseminate throughout the peritoneal cavity and settle on serosal surfaces. This process inevitably leads to the development of peritoneal carcinomatosis.
Pathomorphology and invasive growth
To study the histological picture of gastric cancer, tissue sections are traditionally stained with hematoxylin and eosin. A classic example is well-differentiated tubular adenocarcinoma.
The primary morphological criterion of malignancy in this case is invasive growth. Under the microscope, atypical glandular complexes are clearly visible destroying the normal histoarchitecture and aggressively invading the muscularis mucosae.
Cellular and tissue atypia
Malignant transformation is accompanied by profound changes at the cellular and tissue levels.
Cellular changes are characterized by pronounced atypia: the normal structure of cells is severely disrupted. High mitotic activity is observed. Numerous mitotic figures appear in the field of view, among which atypical mitoses—pathological forms of division specific to malignant growth—draw special attention.
Tissue changes manifest as the loss of normal glandular differentiation. This is expressed by the fusion of glands with one another and the complete disappearance of their lumens. Against the background of these structural breakdowns, signs of cellular atypia become even more evident, forming the classic picture of a malignant tumor.
Briefly: answers to topical questions
Where are the regional lymph nodes located that are affected during orthograde metastasis of gastric cancer?
In orthograde lymphatic metastasis of gastric cancer, the first metastases are identified in regional lymph nodes located along the greater and lesser curvatures of the stomach. First-order lymph nodes also include groups situated directly along the lesser and greater curvatures, as well as in the cardia and pyloric regions; the specific composition depends on the location of the primary process.
What eponymic retrograde metastases are characteristic of gastric cancer?
Gastric cancer is characterized by the following distant retrograde metastases:
- Virchow's metastasis — to the left supraclavicular lymph node;
- Krukenberg's metastasis — to the ovaries;
- Schnitzler's metastasis — to the pararectal tissue.
To which organs does hematogenous metastasis of gastric cancer occur?
Hematogenous metastasis of gastric cancer occurs to the liver, bones, brain, and skin. Sources also note hematogenous metastases of gastric cancer to the lungs.
Through which venous system does gastric cancer hematogenously metastasize to the liver?
Hematogenous metastasis of gastric cancer to the liver occurs via the portal vein system. This is due to the anatomical patterns of venous drainage: tumor emboli from organs drained by the portal vein (which include the stomach, as well as the intestines and pancreas) primarily reach and lodge in the liver.
For quick memorization of classic retrograde lymphogenous metastases, use the phrase "Virchow brought Schnitzel to Krukenberg": Virchow's (supraclavicular node), Krukenberg's (ovaries), Schnitzler's (pararectal tissue).
Class and exam questions
How many metastatic pathways are characteristic of gastric cancer?
A malignant gastric tumor metastasizes via three main pathways. These include the lymphatic pathway (which is predominant), the hematogenous pathway (via blood vessels), and the implantation pathway (contact spread of cells).
Where do the first lymphatic metastases go?
The initial tumor seedings spread via the orthograde pathway, i.e., along the natural lymph flow. They affect regional lymph nodes located along the greater and lesser curvatures of the stomach.
What is Schnitzler's metastasis and how does it develop?
This is a specific distant metastasis of gastric cancer localized in the pararectal tissue. It forms via a retrograde lymphatic pathway, meaning tumor cells move against the normal lymph flow.
What signs of invasive growth are visible under the microscope with hematoxylin and eosin staining?
The main sign of invasion is the penetration of atypical glands into the muscularis mucosae. Concurrently, pronounced tissue atypia is observed: glands fuse together and lose their lumens.
What else to study on this topic
- Mechanisms of orthograde and retrograde lymph movement during tumor growth.
- Pathogenesis of peritoneal carcinomatosis development in contact metastasis.
- Pathological mitotic figures as a key marker of cellular malignancy.
- Morphological signs of the loss of glandular differentiation and glandular fusion.
- Features of the histological structure of well-differentiated tubular adenocarcinoma.
Master the entire topic in the "Pathological Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Gastric Cancer Metastasis" and 4,414 more pages on the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 153 video lessons on the subject
Other topics in the «Digestive System Diseases» section
Free video lessons: pathological anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.