{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:18:55Z","timestamp":1787649535714,"version":"build-2736575974"},"reference-count":57,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:p>\n                    The microsatellite stable with epithelial to mesenchymal transition (MSS\/EMT) subtype includes some of the most aggressive gastric tumors with the worst prognosis. The purpose of this study is to characterize the MSS\/EMT subtype by investigating potential associations with clinicopathologic features and specific elements of the tumor microenvironment: tumor-infiltrating lymphocytes and tumor budding. From a retrospectively collected bi-centric cohort, we first selected microsatellite stable samples and then assessed the immunohistochemical expression of E-cadherin, \u03b2-catenin, and zinc finger E-box binding homeobox 1 to identify the epithelial to mesenchymal transition. Our findings revealed that the MSS\/EMT subtype represented 43% of our series, which was a high prevalence compared to previous studies. This subtype included patients who were significantly younger than non-MSS\/EMT patients (\n                    <jats:italic toggle=\"yes\">p\u2009=\u2009<\/jats:italic>\n                    .017). It was associated with diffuse and mixed-type histology (\n                    <jats:italic toggle=\"yes\">p\u2009=\u2009<\/jats:italic>\n                    .047) and with nonconventional carcinomas (\n                    <jats:italic toggle=\"yes\">p\u2009=\u2009<\/jats:italic>\n                    .023). The MSS\/EMT did not correlate with the advanced stage. Regarding the tumor microenvironment elements, the MSS\/EMT subtype was associated with low density of tumor-infiltrating lymphocytes (\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    \u2009&lt;\u200910\n                    <jats:sup>\u22123<\/jats:sup>\n                    ), while no association was found with tumor budding score. In conclusion, the highly prevalent and distinct MSS\/EMT gastric cancer subtype features low tumor-infiltrating lymphocyte density, suggesting an immunosuppressive tumor microenvironment and therapy resistance.\n                  <\/jats:p>","DOI":"10.1177\/10668969251382887","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:14:11Z","timestamp":1763403251000},"page":"612-621","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Phenotypic Profile of Microsatellite Stable with Epithelial to Mesenchymal Transition Subtype in Gastric Adenocarcinoma"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2058-3461","authenticated-orcid":false,"given":"Marwa","family":"Lakhal","sequence":"first","affiliation":[{"name":"University Tunis El-Manar of Tunis"},{"name":"Faculty of Medicine of Tunis, Research Laboratory of Human Genetics (LR99ES10), University Tunis El-Manar of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9150-3444","authenticated-orcid":false,"given":"Sarra","family":"Ben Rejeb","sequence":"additional","affiliation":[{"name":"University Tunis El-Manar of Tunis"},{"name":"Faculty of Medicine of Tunis, Pathology Department, University Tunis El-Manar of Tunis, Tunis, Tunisia"},{"name":"Department of Pathology, Internal Security Forces Hospital of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6481-6110","authenticated-orcid":false,"given":"Alia","family":"Zehani","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, Pathology Department, University Tunis El-Manar of Tunis, Tunis, Tunisia"},{"name":"Research Laboratory of Investigation and Management of Inherited Metabolic Diseases (LR12SP02), Tunis, Tunisia"},{"name":"Department of Pathology, La Rabta Hospital of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slim","family":"Haouet","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, Pathology Department, University Tunis El-Manar of Tunis, Tunis, Tunisia"},{"name":"Department of Pathology, La Rabta Hospital of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2968-8630","authenticated-orcid":false,"given":"Maher","family":"Kharrat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, Research Laboratory of Human Genetics (LR99ES10), University Tunis El-Manar of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0181-1155","authenticated-orcid":false,"given":"Khadija","family":"Bellil","sequence":"additional","affiliation":[{"name":"University Tunis El-Manar of Tunis"},{"name":"Faculty of Medicine of Tunis, Pathology Department, University Tunis El-Manar of Tunis, Tunis, Tunisia"},{"name":"Department of Pathology, La Rabta Hospital of Tunis, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15010074"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12957-022-02699-8"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12061689"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/apm.1965.64.1.31"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/his.13975"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/1878-0261.13654"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0238836"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3892\/br.2023.1640"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3850"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.19985"},{"issue":"11","key":"e_1_3_3_13_2","first-page":"2141","article-title":"Epithelial-mesenchymal transition in gastric cancer","volume":"7","author":"Huang L","year":"2015","unstructured":"Huang L, Wu RL, Xu AM. 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