Yoshifumi Kodama

Evaluation of extensive lymph node dissection for carcinoma of the stomach.

We compared the results of curative resection for carcinoma of the stomach in 254 patients who underwent simple resection (SR) and 454 patients who underwent extensive regional lymph node dissection (ELD). The 5-year survival rates of the 2 procedures were significantly different in carcinoma involving the serosa of the stomach; it was 45% in the ELD group and 18% in the SR group (p<0.001). In patients with regional lymph node metastasis we obtained a 5-year survival rates of 39% and 18% by ELD and SR, respectively (p<0.001). The incidence of metastasis to the secondary lymph nodes, removable only by ELD, was higher in cases with carcinomatous invasion of the deeper layers of the gastric wall, and this may have been the reason why ELD proved to be more effective than SR. ELD is discussed in relation to the site of the primary carcinoma and the extent of lymph node metastasis.

Differentiation of growth patterns of early gastric carcinoma determined by cytophotometric0 DNA analysis

Cell nuclear DNA content was microspectrophotometrically measured in 60 cases of early and six of advanced gastric carcinoma. DNA distribution pattern was classified into Types I, II and III, according to the degree of dispersion on the DNA histogram. Five of 6 cases of the advanced carcinomas were Type III. In early carcinoma, the majority of Super (superfically spreading) type were Type II, while all of Pen A (expansively penetrating growth) type were Type III. In Pen B (infiltratively penetrating growth)type, six of ten cases were Type II and the other four were Type III. Thus, there was a distinct difference in the DNA pattern between Super and Pen Types, i.e., the DNA analysis reflected these growth types. Since about 20% of those with small mucosal carcinomas, not classifiable into the Super or the Pen types presented Type III, the cytophotometric DNA analysis should be useful in the detection of Pen A like carcinoma, in its early stage. The development from early stage. The development from early to advanced carcinoma was discussed in terms of the similarity of the DNA histogram patterns.

Recurrence in early gastric cancer. A pathologic evaluation

The cause of death in 26 of 220 cases of early gastric carcinoma was studied, particularly in relation to the mode of recurrence. Of the 26, 7 patients died of disease related causes and gross appearance revealed that 4 cases were IIa predominant, 2 were IIc (or +I), and 1 was IIc predominant. Histologic examination indicated that all 7 cases were differentiated‐type adenocarcinomas. Two of 7 recurring carcinomas were due to residual carcinoma in the resected stumps and 5 patients had hematogenous metastases, particularly in the liver. Eighteen of the 26 patients died of other causes, in 1 case of unknown causes, and it is interesting that in 5 of the 18 cases, simultaneous or nonsimultaneous double carcinomas at sites other than the stomach were noted. In order to prevent recurrence in early gastric carcinoma, it is important that no carcinoma be left in the resected stump or remnant, and that the prophylaxis be achieved through the administration of adequate amounts of anticancer chemotherapy, in order to prevent hematogenous metastasis, particularly to the liver. Cancer 46:168–172, 1980.

Late results of postoperative long term cancer chemotherapy for advanced carcinoma of the stomach

Postoperative long term cancer chemotherapy (PLCC) with the combination of Mitomycin-C, FT-207*, a furanyl analog of 5-fluorouracil, and PSK**, an immunopotentiator, was prescribed for patients with advanced gastric cancer. Five year survival rates for all stage III and stage IV patients were 52.8 and 19.3 per cent in the PLCC group. The rates were 26.7 and 2.2 per cent in the control groups (p<0.05). In curative cases of stage IV, the 5-year survival rate was 50.0% in the PLCC group while the rate was 11.1% in the controls. Mean survival time of patients with peritoneal dissemination or hepatic metastases was 12.8 and 10.9 months, respectively, for the PLCC group, in contrast to the lower 6.4 and 4.3 months for the controls. Thus, the 5-year survival rate of advanced gastric cancer patients in stage III and stage IV was markedly improved when these patients were treated with the protocol. Our findings clearly show that adjuvant chemotherapy should be administered for a long period postoperatively in order to achieve a significant improvement in patients with gastric cancer.

Apocrine Adenocarcinoma of the Bilateral Axillae

A case of apocrine adenocarcinoma arising in the bilateral axillae is reported. The patient was an 88 year old Japanese male who complained of a mass lesion and puslike discharge in the right axilla. Another mass was also noticed in the left axilla. No other neoplastic lesion was found in other sites of the body. The histologic appearances of the bilateral axillary tumors were almost identical. Both were adenocarcinoma with varying degrees of differentiation, composed of glands and nests of atypical epithelial cells with abundant eosinophilic cytoplasm. Some neoplastic cells exhibited cytoplasmic projections on their apical surface. Foci of in situ carcinoma were observed within the neoplastic tissue in the bilateral axillae. The neoplastic cells were immunohistochemically positive for epithelial membrane antigen (EMA) and gross cystic disease fluid protein (GCDFP‐15), but negative for carcinoembryonic antigen (CEA). On the basis of their histologic and immunohistochemical features and distinctive location, the tumors were diagnosed as apocrine adenocarcinoma. Acta Pathol Jpn 41: 927‐932, 1991.

Carcinomas of the stomach in the young adults

The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.

Combined effect of prophylactic lymphadenectomy and long term combination chemotherapy for curatively resected carcinoma of the stomach

Effectiveness of prophylactic extensive lymph node dissection (PELD) plus postoperative long term combination chemotherapy (PLCC) for patients with curatively resected gastric carcinoma was assessed in terms of the degree of serosal invasion and lymph node metastasis. Either the Group 1 and Group 2 lymphnodes were eradicated by PELD. PLCC included intermittent intravenous administration of mitomycin C (0.4 mg/kg intraoperatively followed by 0.2 mg/kg every 3 months) and oral administration of Tegafur (600–800 mg/day) and PSK (3.0 g/day), an immunostimulator, for as long a period as possible. PELD alone resulted in a cure when the malignancy was confined to the mucosal and muscular layers of the stomach as well as to the Group 1 lymph nodes. In cases when the carcinoma involved the serosa and/or the Group 2 lymph nodes, the 5 year survival rate was about 55 per cent the PELD and PLCC groups, such being significantly higher than about 27 per cent in the PELD alone group. Therefore, PELD plus PLCC is highly effective for advanced gastric carcinoma, under a condition of curative resection.

Reactive hyperplasia of paracortex and germinal centers of the regional lymph nodes in gastric carcinoma cases as a favorable prognostic indicator

The prognosis of 141 patients subjected to curative resection for gastric carcinoma was analyzed with special reference to the paracortex, germinal centers and sinus histiocytes in the regional lymph nodes. Five year survival rates of the patients with paracortical and/or germinal center hyperplasia (PH and/or GH) was definitely superior to those without such hyperplasia. This difference was most pronouced in those with moderately advanced stage. The incidence of lymph node metastasis was lower in the patients with PH or GH. The presence of sinus histiocytosis (SH) seemed to be correlated neither with a longer survival nor with lower incidence of lymph node metastasis. No close correlation was found between Ph, GH and SH on one hand and histological types of the primary gastric carcinomas on the other. These results suggest that cell mediated and/or humoral immune response may play an important role in host resistance against gastric carcinoma.

Postoperative long-term cancer chemotherapy (PLCC) extends life-span of non-curatively resected patients with stage IV gastric cancer

Postoperative long-term cancer chemotherapy (PLCC) with a combination of Mitomycin-C, Tegafur and PSK (an immunostimulant) was applied to non-curatively resected cases with stage IV gastric cancer (invading the adjacent organs and/or with metastasis to the liver, peritoneum, and/or distant lymph nodes). This approach has a significant life-prolongation effect. The two-year survival rate was 16.8 per cent in the PLCC group, such being higher than 6.7 per cent and 1.7 per cent in MMC and no chemotherapy groups (p<0.05). 50 per cent survival periods in those with liver metastasis were 8.3 months in the PLCC group, such being longer than 5.2 and 2.8 months in MMC and no chemotherapy groups (p<0.002) respectively. Combination therapy of PLCC and intra-arterial infusion of 5-FU through the proper hepatic artery prescribed for 8 patients with liver metastasis resulted in a 3-month prolongation of 50 per cent survival periods, compared with PLCC alone (p<0.05). In those with peritoneal dissemination the rate was 10.5 months in the PLCC group, that is longer than 6.5 months in the MMC group (p<0.02). In cases of invasion to other organs plus distant lymph node metastasis, the time was 11.0 in PLCC and 7.0 months in MMC groups (p<0.05). Thus, PLCC is a palliative approach for non-curatively resected carcinoma of the stomach.

THROMBOPLASTIC AND FIBRINOLYTIC ACTIVITIES OF V2 AND V7 CARCINOMAS OF RABBIT, WITH SPECIAL REFERENCE TO FIBRIN DEPOSITION AND THROMBUS FORMATION IN THE TUMORS

Thromboplastic and fibrinolytic activities of V2 and V7 carcinomas, the two transplantable rabbit tumors of the same viral origin, were studied in relation to fibrin deposition and thrombus formation in the tumors. Thromboplastic activity of V7 carcinoma was comparatively high, while that of V2 carcinoma was as low as that of muscle tissue. More fibrin deposits in the stroma and more thrombi in the small vessels were found at the advancing border of V7 carcinoma than that of V2 carcinoma. These differences might be associated with higher thromoboplastic activity of V7 carcinoma than that of V2 carcinoma. Fibrinolytic activity of both tumors was high and it was confirmed to be localized in the tumor cells by Todds method. Fibrin deposits in the stroma were found more abundantly somewhat apart from the advancing border of the tumor nests of both tumors. It was suggested that plasmin activated by plasminogen activator released locally from the tumor cells might digest fibrin deposited in the stroma just close to the tumor nests.