Early gastric carcinomas in the cardiac region: diagnosis with double-contrast x-ray studies.

BACKGROUND: The ratio of early to advanced gastric carcinomas in the cardiac region is significantly low. It is necessary to establish methods of early diagnosis of gastric carcinomas in the cardiac region. METHODS: Twenty cases (21 lesions) of early gastric carcinomas in the cardiac region were resected between 1997 and 2001. We studied the macroscopic characteristics of the specimens, films of double-contrast upper gastrointestinal studies before operations, and the detectabilities of findings in each projection. RESULTS: Four of 21 early gastric carcinomas in the cardiac region were on the anterior wall, 10 were on the lesser curvature, and seven were on the posterior wall. In seven of 21 lesions the carcinomas were not detected in the resected specimens macroscopically; in five, the area of carcinoma was not clearly traced in the resected specimens; and in nine, the area of carcinomas was clearly traced. In the morphologic study, 16 (76.2%), two (9.5%), two (9.5%), and one (4.8%) of the 21 lesions showed the superficial depressed type (IIc), superficial elevated type (IIa), superficial elevated and superficial depressed type (IIa + IIc), flat and superficial depressed type (IIb + IIc), respectively. Mucosal reddening was seen in 11, and mucosal discoloration was seen in one; change of color was not seen in the remaining nine lesions. Twenty lesions were diagnosed as differentiated adenocarcinomas, and one lesion was diagnosed as undifferentiated adenocarcinoma. Radiologically, early gastric carcinomas in the cardiac region had the following features: localized shallow barium deposits, localized abnormal barium coating, and niche and radiolucent lesions. Four (100%) of four lesions on the anterior wall, 10 (100%) of 10 lesions on the lesser curvature, and seven (100%) of seven lesions on the posterior wall were detected in the half-standing, prone, right anterior, oblique projection. Seven (100%) of seven lesions on the posterior wall and 10 (100%) of 10 lesions on the lesser curvature were detected in the half-standing, supine, left anterior, oblique projection. CONCLUSION: Even though most early gastric carcinomas in the cardiac region demonstrate few macroscopic findings, the half-standing, prone, right anterior, oblique projection and the half-standing, supine, left anterior, oblique projection are useful in the double-contrast studies.

Eosinophilic granuloma of the stomach mimicking gastric cancer, report of a case.

We report a rare case of eosinophilic granuloma of the stomach mimicking gastric cancer. A 49-year-old man was admitted to our hospital to undergo surgery for gastric tumor. Radiologic and endoscopic examination showed a protruding tumor with a deep ulcer at the anterior wall of the pylorus. Although malignant cells were not histologically confirmed in the biopsy specimens, subtotal gastrectomy with lymphadenectomy was performed because gastric cancer was strongly suspected. The gross appearance of the tumor seemed to be that of a gastric cancer, but the histological diagnosis was eosinophilic granuloma. If submucosal tumor of the stomach is suspected, eosinophilic granuloma should be considered as one of the differential diagnoses. Endoscopic removal of the tumor may be useful to make a precise diagnosis before surgery.

The role of thymidine phosphorylase expression in the invasiveness of gastric carcinoma.

BACKGROUND: Thymidine phosphorylase (TP) has angiogenic activity in various cancer tissues. Gastric carcinomas are classified into two histologic groups: differentiated and undifferentiated adenocarcinomas. There are differences in the modes of development and the extent of infiltration between the two groups. The purpose of the current study was to determine whether TP is involved in the invasiveness and progression of these two types of gastric carcinoma. METHODS: To investigate the expression and localization of TP and the microvessel counts, the authors examined specimens from 149 gastric carcinoma patients. The specimens were stained using monoclonal antibody against TP and polyclonal antibody against factor VIII. To determine the cell type expressing TP, immunohistochemical staining using a monoclonal antibody against CD68 that is specific for macrophages and double staining using antibodies to both TP and CD68 were performed. RESULTS: The proportion of TP positive tumors in differentiated adenocarcinomas was higher than that in undifferentiated adenocarcinomas. The TP positive differentiated adenocarcinomas invaded more deeply than the TP negative ones, but this was not the case with undifferentiated adenocarcinomas. TP was expressed mainly in the invasive edges of tumors and was expressed more frequently in macrophages than in tumor cells. TP expression was correlated with microvessel count and CD68 expression. Patients with TP positive carcinomas had a poorer prognosis than those with TP negative differentiated adenocarcinomas. CONCLUSIONS: TP expressed in macrophages may be correlated with microvessel count and play an important role in tumor invasiveness and progression in differentiated gastric adenocarcinoma.

[Macroscopic and histological studies on the gastric carcinoma having arisen from the cardiac gland mucosa--concerning to the esophageal invasion and the reliable surgical cut-line].

Cardiac carcinoma is defined as the carcinoma whose center of the mucosal lesion is located at the area of the stomach within 2.0cm from the esophago-gastric junction. Histological and macroscopical examination was performed concerning to the frequency of macroscopic type, the direction of the mucosal invasion, the tendency of the submucosal invasion and the esophageal invasion by using these cardiac carcinomas. The objects of this study are a hundred and thirty-nine cases of cardiac carcinomas. The conclusions are as follows: 1) Depressed type (Type II c) in early carcinoma, Type Borrmann 2 and Borrmann 3 in advanced carcinoma are the most frequent form of macroscopic types. 2) The majority (87.7%) of the early carcinomas was situated at the lesser curvature and the posterior wall of the cardiac mucosa (Figure 1). 3) The early cardiac carcinoma had a tendency to invade in the mucosal layer along the esophago-gastric junction (Table 2). 4) The cardiac carcinoma was thought to invade into the submucosa in its early phase, comparing to the carcinoma on the other area of the stomach (Table 3). Twenty-four out of thirty-five (68.6%) cases of cardiac carcinoma ranged from 11 to 20mm in diameter invaded into the submucosa (Table 3). 5) Twelve out of seventy-three (16.4%) of early cases and fifty-seven out of sixty-six (86.4%) of advanced cases showed the infiltration into the esophagus (Table 4, Figure 6). The reliable and surgical cut-line of the oral site can be established at the area over 11 mm in the distance from the oral margin of the mucosal invasion in the cases of early cardiac carcinoma, over 25mm in the cases of advanced differentiated type, and over 30mm in the cases of advanced undifferentiated type (Figure 6).

[Endoscopic analysis of gastric mucosal lesions in patients with adult T-cell leukemia during chemotherapy].

Gastric mucosal lesions in 13 patients with adult T-cell leukemia (ATL) were endoscopically studied at least at 2 occasions during chemotherapy for these patients. X-ray examinations by using barium meal showed deformities in 10 patients and abnormal mucosal pattern in 11 out of 13 patients with ATL. The endoscopic examinations revealed gastric ulcers in 5 patients, erosion in 8, diffuse bleeding in 2, tumorous mucosal folds in one, and submucosal tumor in one patient. In 9 out of 12 ATL patients, pathological study revealed that ATL cells had invaded the mucosal area of the stomach. The ulcers and erosions were improved by chemotherapy in 3 out of 5 and 5 out of 8 patients, respectively, whereas the erosion was not reduced in 2 and even aggravated in one patient. Interestingly, the gastric lesions formed by ATL cell invasion were improved by the administration of anticancer agents in 5 out of 9 patients. However, these lesions reappeared together with systemic lesions of ATL.

[Hemolytic anemia complicated with Behçet's disease and myelodysplastic syndrome].

A rare case of hemolytic anemia complicated with Behçet's disease and myelodysplastic syndrome (MDS) is described. A 41-year old woman suffering from hemolytic anemia was admitted in July of 1988 with right lower abdominal pain and a high fever. Her anemia was first pointed out in 1962 (at age 15), and diagnosed as hemolytic anemia in 1977 by a full hematological examination showing erythro-hyperplasia in bone marrow, Coomb's test was negative and corticosteroid therapy failed to improve her anemia. She had also been suffering from recurrent stomatitis and genital ulcer since the delivery of her first baby in July, 1972. Barium enema was performed and revealed a simple deep ulcer at the terminal ileum. Bone marrow examination showed morphological abnormalities of granulocytic and erythrocytic series. We thereby diagnosed her illness as incomplete Behçet's disease and MDS associated with hemolytic anemia. She was treated by ubenimex, blood transfusion and intravenous alimentation with discontinuing oral intake, and there was a satisfactory improvement in pancytopenia and ulcer.

[Radiographic and endoscopic diagnosis of gastric cancers in the esophago-gastric region].

The basic study for x-ray diagnosis and endoscopic one of early gastric cancer in the cardiac region was made. 30 cases of early gastric cancer were investigated for this purpose. The half-standing prone right anterior oblique projection and the half-standing supine left anterior oblique one were indispensable in routine x-ray examinations to detect the early gastric cancer in the cardiac region. Such findings as irregularly shaped barium fleck or irregular collection of the barium with faint granularity should carefully be checked up in terms of x-ray diagnosis of early gastric cancers in the cardiac region. Such findings as reddish discoloration and mucosal unevenness should carefully be checked up in terms of endoscopic diagnosis of early gastric cancers in the cardiac region.