Hiroshi Yamagiwa

Hepatoid adenocarcinomas of the stomach: an analysis of seven cases

Hepatoid adenocarcinomas of the stomach are gastric carcinomas with both adenocarcinomatous and hepatocellular differentiations. They usually produce large amounts of alpha‐fetoprotein (AFP) with a Concanavalin A‐binding property of hepatic type. In this study, these carcinomas occurred in older persons, with the antrum being a common site. Observed grossly, growth of the tumors was nodular and massive. Prognosis was poor because of frequent liver metastases. In the cytoplasms of tumor cells, various serum proteins were identified, including AFP, alpha‐1 antitrypsin (AAT), alpha‐1 antichymotrypsin (ACT), albumin, and prealbumin. Localizations of ferritin, prothrombin, and transferrin were demonstrated with less frequency. Adenocarcinomatous foci were composed of well‐differentiated, intestinal‐type epithelial cells and often contained carcinoembryonic antigen. These adenocarcinomatous and hepatoid areas were often intermingled with each other. There were extensive venous involvements by tumor cells. The poor prognosis of the tumors may be attributed to these involvements as well as to production of AFP and presence of AAT/ACT, which have immunosuppressive and protease‐inhibitory properties, respectively. Cancer 58:119–126, 1986.

INTESTINAL METAPLASIA‐DYSPLASIA‐CARCINOMA SEQUENCE OF THE GALLBLADDER

One thousand cases of respected gallbladders were histologically investigated by serial step sections. Intestinal metaplasia was found at rates of 4.0% and 30.6% in the cases without and with stone, respectively. It was found at rates of 69.8% and 61.1% in the cases of dysplasia and carcinoma, respectively. The goblet cells were found at rates of 34.5% and 26.3% in the lesions of carcinoma and dysplasia, respectively. On the other hand, the dysplasia and adenoma Intermingled in the tumor tissue at the rates of 22.2% and 8.3% in 36 cases of carcinoma, respectively. Although normal epithelial cells of the gallbladder contain mainly sulfomucln, the goblet cells have sialomucin. The ratio of sialomucin‐containing cells increased in the tissue of dysplasia and carcinoma. As to their location, intestinal metaplasia, dysplasia, and carcinoma showed a similar distribution in the gallbladder. Accordingly, it should be considered that the sequence of intestinal metaplasia‐dysplasia‐carcinoma is significant Pseudo‐pyloric glandular metaplasia was found at rates of 45.5% in the cases of cholecystitis without stone, 77.2% in those with stone, 100% in those with dysplasia, and 72.3% in those with carcinoma. However, it should be considered that pseudo‐pylorlc glandular metaplasia has less relationship for the bases of carcinogenesls as compared with intestinal metaplasia.

HETEROTOPIC GASTRIC GLANDS IN THE SUBMUCOSA OF THE STOMACH

The submucosal heterotopic gastric glands were found in 160 cases (10.7%) of 1500 resected stomachs; 15% in gastric ulcer, 9.9% in gastric carcinoma, 4% in duodenal ulcer and 11% in chronic gastritis. The heterotopic glands were usually found in the distal half of the stomach, diffusely or localized. Macroscopic submucosal tumor was found in 9 (5%) of 160 cases. Although the heterotopic glands were found with an intimate relation to the repeated mucosal damage and subsequent intestinal metaplasia, they had no specific relation to gastric carcinogenesis. ACTA PATH. JAP. 29: 347–350, 1979.

DYSPLASIA OF GALLBLADDER

Twenty‐three cases of dysplasia of the gallbladder and 38 cases of carcinoma with surrounding dysplasia were investigated. The dysplasia did not show any remarkable lesion and consisted of atypical basophilic cells with oval or round nuclei. The ratio of nucleus to cytoplasm (N/C) ratio was usually larger than the normal epithelial cells. For the combined dysplasia, it has been considered that 1) the dysplasia arose as well‐differentiated carcinoma, 2) appeared synchronously, 3) arose secondarily, and 4) appeared as a precancerous lesion. Intestinal metaplasia, dysplasia, and carcinoma showed similar characteristics as to location and mucin‐chemistry. According to CEA stain by PAP method, the dysplasia and carcinoma showed similar characteristics. It may be considered that the sequence of intestinal metaplasia‐dysplasia‐carcinoma is important.

PATHOLOGICAL STUDY OF MULTIPLE GASTRIC CARCINOMA

Multiple gastric carcinoma was investigated on 101 of 1901 resected stomachs. The frequency of multiple carcinoma was 4.7% and 6.9% of the advanced and early carcinomas, respectively. Male to female ratio was 2.9 to 1 with average age of 62.0 and that was 1.9 to 1 with average age of 57.7 in the total gastric carcinomas. The well‐differentiated carcinomas with intimate relation to the intestinal metaplasia increased by aging and occupied about 70% of all lesions. The intestinal metaplasia usually showed higher grade in the cases with multiple carcinomas than those with single lesion. It should be considered that intestinal metaplasia plays the important role in the histogenesis of gastric carcinoma, especially in that of the well‐differentiated one.

Heterotopic pancreas in surgically resected stomach.

SummaryThe heterotopic pancreas collected from the surgically resected stomachs were studied clinico-pathologically. The number of the cases of heterotopic pancreas were 64; 43 in the stomach and 21 in the duodenal bulbus. They were corresponded to 1.2% in the 5446 resected stomachs. The operated cases with this lesion were frequently found in the age of thirty to fifty with male predominance. Thirty eight cases of them were combined with other gastro-duodenal diseases, especially gastric or duodenal ulcers. About 90% of these lesions were found in the pylorus and antrum. They were situated frequently in the greater curvature, posterior and anterior wall, and rarely in the lesser curvature. Their size was ranged about 0.3 to 4.7 cm in diameter, and about 80% of them within 3 cm in diameter. Macroscopically, 49 polypoid, 8 nipple-like, 7 flat and 1 thickening folded lesions were found, respectively. The bridging folds were found in 9 cases, 13.8%. Microscopically, 30, 29 and 6 lesions of type I, II andIII types according to Heinrich’s classification were found, respectively. The ulcer formation of the mucosal surface of the heterotopic pancreas was found at rate of 10%, and cystic transformation in about 6%.

PROTRUDED VARIANTS IN SOLITARY ULCER SYNDROME OF THE RECTUM

A review of 21 patients with protruded lesions in solitary ulcer syndrome of the rectum confirmed by resection is presented. Symptoms were usually the passage of blood and mucus per rectum, alteration of bowel habit, anorectal pain and rectal prolapse. Solitary or multiple polypoid lesions were found within 15 cm of the anal margin and were usually sited anteriorly. Fifteen of the patients were men and 8 were women with a mean age of 37.1 years. The diagnosis was made on the basis of histopathology; 1) fibrous obliteration of muscle fibers, 2) reactive hyperplasia of the mucous membrane with villous configuration or mild pseudoinvasion. These changes have been observed in complete rectal prolapse, colonic intussuception, and localized colitis cystica profunda, suggesting a common pathogenesis. The histological findings were almost the same as in the ulcerative lesions of this syndrome except for remarkable regenerative hyperplastic changes such as a relatively high incidence of mucous cell proliferation, dilatation of glands and serrate change in the cases showing protrusion. In the pathogenesis, the occult mucosal prolapse in association with excessive straining may be of particular importance, so that the lesions might be termed mucosal prolapse syndrome of the rectum.

Heterotopic Pancreas of the Stomach

Ordinary histological investigation has suggested that heterotopic pancreas of the stomach may have two types of histogenesis; one is development from immigrated fetal pancreas tissue, and the other is development from primitive gastric mucosal epithelium following penetration into the submucosa with subsequent erroneous differentiation into pancreas tissue. It is suspected that type I lesions include the majority of cases caused by immigration from fetal pancreas, and that some type II cases arise through erroneous differentiation of primitive gastric mucosal epithelium. With regard to immunohistochemical findings, cells positive for pancreatic polypeptide and amylase were much more numerous in the acini of type I cases compared with type II cases. Positive cells were found not infrequently in the acini of type II cases after staining for pancreatic polypeptide, insulin, glucagon, somatostatin, serotonin, and gastrin. On the other hand, a small number of cells in islets were not infrequently positive for α1–antitrypsin, α1,‐antichimotrypsin, and amylase. It is considered that in the heterotopic pancreas, ductal cells have the potential to differentiate into acinar cells and islet cells, as is the cases in the orthotopic pancreas. Acta Pathol Jpn 42 : 249 254, 1992.

Clinicopathological study of gastric leiomyogenic tumors

Summary1.Seventy cases of the leiomyogenic tumors were found in 5451 resected stomachs; 49 leimyoma, 17 leiomyosarcoma and 4 Ieiomyoblastoma. These leiomyogenic tumors occupied 40.5% of 173 submucosal tumors of the stomach.2.The average age was 51.7 in leiomyoma, 57.3 in leiomyosarcoma and 41.6 in leiomyoblastoma with male predominance.3.The leiomyoma and leimyosarcoma were frequently found in the upper 2/3 of the stomach.4.The size of the tumors was within 3 cm in diameter in about 80% of leiomyoma with ulcer formation of 10.2% and over 3 cm in about 88% of leiomyosarcoma with ulcer formation of 64.7%.5.The classification of the the leiomyogenic tumors into the benign and malignant was occationally difficult. For the diagnosis of the leiomyosarcoma, the number of mitosis, irregularity of nucleus, increase of cellularity and decrease of smooth muscle production were helpful.

Clinico-pathological study of juvenile polyp of large intestine.

Although the difference of juvenile polyps between the childhood and adult groups was investigated, no significant difference could be pointed out both clinically and histologically. Since the polyps showing similar pathological findings were examined in the present investigation, it should be considered as a matter of course that no significant difference by age was pointed out. In a sense, these facts revealed the existence of a juvenile polyp which occurs in adult patients. In fact, the incidence of juvenile polyp which occurs in adult patients beyond the age of 20 has been estimated as 0 to 44% in the literature. If the term of juvenile polyp is not preferable in the adult cases, the term adult juvenile type polyp may be useful. Although several theories like as hamartoma, inflammation, allergy, etc. have been discussed for its histogenesis, it may be difficult to understand the histogenesis of juvenile polyps by a single theory.