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Hereditary diffuse gastric cancer (HDGC) is an autosomal-dominant syndrome, accounting for approximately 1% of gastric cancers. The germline pathogenic variant of CDH1, encoding for the tumor-suppressor protein E-cadherin, is implicated in the genetic pathogenesis of HDGC. 1, 2 Patients with a pathogenic variant of CDH1 are recommended to undergo a prophylactic gastrectomy owing to a high cumulative risk of diffusetype gastric cancer over the age of 80 years: 70% for men and 56% for women. 3, 4 Thus, it is important to identify this hereditary cancer syndrome to provide an appropriate treatment.

For some patients with the pathogenic variant of that gene who decline to undergo prophylactic gastrectomy, histologic assessment of the presence of microscopic foci of intramucosal signet-ring cell carcinoma (SRCC) and its precursor lesions (which are characteristic of early HDGC) 5, 6 could be a helpful factor …