Early and advanced gastric cancer during follow-up of apparently benign gastric ulcer: significance of the presence of epithelial dysplasia.

One hundred and forty-four patients with apparently benign gastric ulcer were endoscopically followed up in order to evaluate the outcome of the lesion. Particular attention was given to: (a) detect possible delay in diagnosing gastric cancer; (b) ascertain the frequency of association with epithelial dysplasia; (c) establish the role of markers, such as serum pepsinogen group I (PGI), and gastric juice CEA in predicting gastric ulcer evolution. Endoscopic and bioptic check-ups were carried out during the first year at 3, 6 and 12 months after endoscopic healing of the ulcer, and then at every symptomatic recurrence. Ten patients (6.9%) were found to present histological evidence of malignancy (within 3 months in six cases, between 6 and 12 months in three cases, and after 41 months in the rest). Four cases were early gastric cancers, and six had shown dysplastic changes of the mucosa at the edge or scar of the ulcer. Serum PGI levels were not significantly different in gastric cancer patients, while gastric juice CEA levels were sharply increased compared to those of gastric ulcer patients: nine out of ten patients had values above normal range. These data suggest that: (a) there may be some delay in diagnosing gastric carcinoma, and gastric ulcer patients should be controlled routinely more than once; (b) the presence of dysplasia indicates the need for prolonged follow-up, because of the high risk of association with or evolution into gastric cancer, and because of the higher number of early gastric cancer detections that this protocol allows; (c) further support in monitoring patients "at risk" may be afforded by gastric juice CEA determination.

Prognostic correlations of operable carcinoma of the rectum.

Various histologic factors correlated to survival were studied in 124 patients radically operated on for rectal carcinoma in order to establish valid prognostic criteria. The total survival rate after five years was 63 percent, while in stage B1 it was 89 percent, in B2, 61 percent, and in C1, 47 percent (P less than 0.05). With regard to histotype, the survival was 83 percent in the papillary subtype of adenocarcinoma, while in the tubular subtype it was 62 percent, and 29 percent in the mucinous type (P = not significant). Vascular invasion negatively affected survival (41 percent); however, when there was no invasion, the prognosis was better (71 percent) (P less than 0.01). In evaluating histologic grading and lymphoglandular reactivity, the difference in survival rates was not statistically significant. The marked peri- and intratumoral lymphocytic infiltration gave a very good prognosis (92 percent) contrary to when reactivity was moderate (59 percent) or even absent (51 percent) (P less than 0.01). Finally, the expanding type tumor, with reference to Ming's classification of gastric carcinoma, had a much better prognosis (75 per cent) than the infiltrative type (40 percent) (P less than 0.01).

Gastric cancer: problems in histogenesis.

Intestinal metaplasia in the mucosa adjacent to a gastric carcinoma suggests that some carcinomas of the stomach might arise from metaplastic mucosa, as well as the existence of a gastric cancer with morphological features resembling intestinal mucosa. In this study, the extent of intestinal metaplasia of adjacent mucosa, the type of intestinal metaplasia (complete or incomplete), the degree of tumour differentiation, the type and quantity of mucins secreted by neoplastic cells and morphological features of the tumours were evaluated in 59 cases of gastric carcinoma. An analysis of the findings suggests that a carcinoma may arise in the stomach with features of association with incomplete metaplasia and histochemical and histological patterns which mimic carcinomas of the large intestine.

Gastric cancer: problems in histological diagnosis.

The reproducibility of the most recent histological classifications for gastric cancer was studied. A comparison of the results obtained independently by both authors using the criteria of Lauren, Ming, Mulligan and WHO, showed that highest reproducibility was achieved with the WHO classification. However, an acceptable accuracy in diagnosis for the other three classifications was obtained. This study confirms the validity of the WHO criterion for initial diagnosis, while the other classifications should be kept for further specific investigations, such as epidemiological or prognostic studies.

Possible indication of breast cancer risk through discriminant functions.

In the Ferrara province of Italy, a screening programme for the detection of breast cancer was initiated in 1965; by 1976, 21,120 women had been examined. The biologic history of the women participating in the program is routinely collected at registration. Several biological variables can be extracted from the history. We used 15 biologic variables in order to construct discriminant functions between women affected by breast cancer and a group of control women. It was found that four variables suffice to separate the group of the women with breast cancer from the control group, although with some degree of uncertainty. The theory was advanced that the individual values of a discriminant function may be associated with the risk of healthy women for developing breast cancer. Data collected after the construction of the discriminant function hint at such an association. We have attempted to calculate a discriminant value for healthy women participating in screening programs, so that those having a discriminant value below a given threshold may be considered at higher risk than those above the threshold. The women in the high-risk group may then be submitted to an appropriate examination schedule.

Prognostic significance of the cyto-histological classification of infiltrating cervical epidermoid carcinoma.

One hundred-fivty-five cervical carcinomas were classified according to the Wentz and Reagan (21) cyto-histological system, and correlated to 5 year survival rates. This classification subdivides epidermoid carcinomas into three sub-groups: keratinizing carcinoma, large cell carcinoma, and small cell carcinoma. No significant differences between one group and another were observed. The importance of the type of therapy in conditioning the significance of this classification system is discussed.