Characterization of Gastric Mucinous Carcinoma: Clinicopathological Insights and Vascular Features via MSCT

To compare the clinicopathologic characteristics, Multi-slice Spiral CT (MSCT) vascular features, and angiogenesis profiles among mucinous gastric carcinoma (MGC), gastric carcinoma with <50% extracellular mucin pool (LEMPC), and non-mucinous gastric carcinoma (NMGC), and to explore imaging-angiogenesis associations underlying subtype-specific enhancement patterns.

Clinical, radiological, and pathological data from patients with MGC, LEMPC, and NMGC were analyzed in a three-group comparative design. Microvessel density (MVD) and the expression of vascular endothelial growth factor A (VEGF-A), hypoxia-inducible factor-1 alpha (HIF-1α), and epidermal growth factor (EGF) were evaluated by immunohistochemistry in cancerous and corresponding paracancerous normal tissues. Correlations between MSCT features and histopathological parameters were assessed.

Overall survival was lower in the MGC group than in the NMGC group (P = 0.021). Enhanced MSCT demonstrated significant intergroup differences in maximum tumor diameter, mucosal integrity, calcification, and enhancement parameters (including range, features, maximum value, and ratio), with MGC more frequently showing intact mucosal lines, calcifications, and layered enhancement. Angiogenesis-related assessments showed lower MVD in MGC than in NMGC (P < 0.001). VEGF-A and EGF expression in cancerous tissues was lower in MGC / LEMPC than in NMGC (P = 0.002, P < 0.001), while HIF-1α expression was similar across all groups. These findings paralleled the lower MSCT enhancement indices observed in MGC.

MGCs, marked by poor differentiation and poor prognosis, exhibit intact mucosal lines, frequent calcification, and stratified enhancement on enhanced MSCT. Reduced MSCT enhancement indices are associated with low angiogenesis, concomitant with decreased VEGF-A and EGF expression.