Masahiko Tsuji

Scirrhous carcinoma of the stomach: a clinical and pathological study of 106 surgical cases.

SummaryClinical and pathological characteristics of scirrhous carcinoma of the stomach were studied in 106 cases treated by gastrectomy between 1973 and 1983. The male to female ratio was 0.58. The percentage of scirrhous carcinomas to all gastric carcinomas resected in the same period was three times higher in females than males. The age distribution of the patients suggested that there were two peaks in the forties and sixties in the male, and in the thirties and fifties in the female. The incidence of scirrhous carcinoma in all types of gastric carcinoma was significantly higher in the twenties, thirties and forties compared to the lowest incidence in the seventies. In the female group the primary lesion had a tendency to be adjacent to the fundic gland area and to avoid intestinal metaplasia. In the male the opposite was recognized. Cancer nests with single cells or only several cells were common in this type of carcinoma. These findings suggest that there might be two biologically different scirrhous carcinomas both in the male and the female, the appearance of single carcinoma cells might be favored by female sex hormones and young ages, and not only the original gastric mucosa but also mucosa with intestinal metaplasia could be precursors of single carcinoma cells.

HISTOPATHOLOGICAL STUDY OF EARLY LESIONS OF PANCREATODUODENAL CANCER

The early lesions of pancreatoduodenal cancer, which was defined as those in which the site of origin is confined in a single certain anatomical part and the mode of early extension can be pursued, were found in 28 of 52 surgical specimens examined; 12 in the pancreatic portion of the common bile duct (PCBD), 12 in the common channel, 1 each in the terminal portion of the common bile duct and the terminal portion of the pancreatic duct, and 2 in the peripapillary zone of the duodenum. There were roughly two types of tumor growth; one annular flat‐raised, histologically scirrhous tubular adenocarcinoma, principally found in PCBD and the other polypoid, histologically papillary or papillotubular adenocarcinoma, found everywhere. The staining properties of mucin was of no value in differential diagnosis for the site of origin. One typical carcinoid was observed in PCBD. The surface spread of carcinoma beyond the originating part was seen in 10 cases (36%), lymphatic invasion in 23 cases (82%), node metastasis in 9 cases (32%), and venous invasion in 6 cases (21%). Only 2 cases were mucosal carcinomas. From these figures it can be concluded that the carcinoma of this region is of high grade malignancy.

Superficial spreading carcinoma with esophageal stricture: A case report

A rare case of a superficial spreading carcinoma with esophageal stricture is described. A 68-year-old man with dysphagia was found to have an upper to middle esophageal stenosis on radiologic examination. Endoscopically, a reddish and slightly depressed mucosa was seen throughout the whole esophagus, and a localized ulcerative lesion was detected in the middle portion. The lesion was negative for iodine staining. A superficial spreading carcinoma of the esophagus was diagnosed. A total esophagectomy with wide lymph node dissection and posterior mediastinal esophagocolectomy were performed. Microscopically, the moderately differentiated squamous cell carcinoma with minute submucosa was seen continuously from the cervical to lower esophagus. The distance of the superficial spread was 15.5 cm.

CLINICAL STUDY OF PANCREATICODUODENECTOMY FOR GASTRIC CARCINOMA

Thirteen patients with gastric carcinoma undergoing pancreaticoduodenectomy (PD group) in a recent one decade were subjected to a historical evaluation of the long term survival by radical operation. These cases were compared with 103 cases undergoing subtotal gastrectomy (non-PD group) for advanced carcinoma occupied lower third of the stomach in the same period. The five-year survival rates were 46% and 21% in PD-group and non-PD group, respectively. When the pancreas head was involved from the main tumor or metastatic lymph nodes, the 5-year survival rate was 53% in PD group, versus no survivors in non-PD group (p<0.05). Recurrence of lymph node metastasis occurred in 9% by Billroth I method, and 21% by Billroth II. For this, the prognosis was estimated in cases with positive lymph nodes of No.12, 13, 14 and 17 which were able to be dissected completely by PD, and resulted in the 2-year survival rates of 50% and 24% in PD and non-PD groups, respectively. These results suggest that PD for advanced carcinomas located in the lower third of the stomach may be recommended to the cases with invasion to the pancreas or metastasis to the lymph nodes around the pancreas head.