Time trends of early gastric carcinoma. A clinicopathologic analysis of 2846 cases.

BACKGROUND: Despite recent improvements in the diagnostic accuracy and techniques for identifying early gastric carcinoma, gastric carcinoma remains a major cause of death in the world. METHODS: The clinicopathologic features of 2846 surgically resected early gastric carcinomas from 1962-1987 were reviewed, and the time trends of a variety of clinicopathologic factors were studied using both an univariate and a multivariate analysis. RESULTS: The differentiated type of carcinoma increased in frequency from 34-50%. The percentage of patients older than 60 years of age increased from 32-56%. The number of lesions measuring less than 3 cm increased from 28-56%. The frequency of shallow-type-IIc carcinomas measuring less than 3 cm, which had been previously difficult to detect and were mainly composed of differentiated carcinomas, increased from 46-69%. The relative proportion of the differentiated type of carcinoma was significantly higher in patients older than 60 years of age than in those younger than 60. The relative proportion of differentiated-type carcinomas measuring less than 3 cm, which had been easy to detect as opposed to undifferentiated-type carcinomas, significantly increased from 56-76%. CONCLUSIONS: The above time trends may indeed reflect genuine change. However, the recent increase in the rate of differentiated-type, small-sized carcinomas also suggests the possibility that such results may, in fact, be due mainly to improvements in both diagnostic accuracy and medical technology. Thus, a large number of undifferentiated-type, small-sized carcinomas might have merely failed to be found in routine gastric examination.

Signet-ring cell carcinoma of the stomach. A quantitative analysis on its submucosal invasion using a computer image analyzer.

As has been indicated, signet-ring cell carcinoma often shows a three-layered pattern of mucus-containing cells in the mucosa, reproducing an organized differentiation in the normal mucosa. In 110 lesions of early stage signet-ring cell carcinoma of the stomach, the proportion between the area with the three-layered pattern and the non-layered area without such layered pattern was measured using a computer image analyzer. As the result, a positive correlation could be demonstrated between the extent of the non-layered area and the tumor size expressed in the largest diameter (r = 0.2777, P < 0.01). The incidence of submucosal invasion significantly increased when the non-layered area exceeded 50% of the total area of signet-ring cell carcinoma. The sites of submucosal invasion were almost always limited to within the non-layered area bearing another positive correlation between the area of submucosal invasion and that of non-layered intramucosal pattern (r = 0.4427, P < 0.01). Thus, it is indicated that the incidence of submucosal invasion in early signet-ring cell carcinoma was significantly related to a dissolution of the three-layered pattern of carcinoma within the mucosa. In addition, the presence or absence of fibrous and lymphoid stromal reactions to the carcinoma was evaluated in relation to the incidence of submucosal invasion.

Pathology and prognosis of gastric carcinoma. Findings in 10,000 patients who underwent primary gastrectomy.

BACKGROUND: Despite recent advances in diagnosis and treatment, gastric carcinoma remains a major cause of death in the world. METHODS: The clinicopathologic profile of 10,000 consecutive patients who underwent primary gastrectomy during 1962-1989 were reviewed and prognostic factors influencing survival in those with gastric carcinoma were analyzed in 7031 patients. RESULTS: Incidence of gastrectomy for carcinoma has increased steadily and the rate of early carcinoma exceeded that of advanced carcinoma in the recent period of 1985-1989. Five-year and 10-year survival rates were 46.1% and 35.2% in 3868 patients with advanced carcinoma, and 88.8% and 77.3% in 3163 patients with early carcinoma, respectively. In patients with advanced carcinoma, significantly poorer survival rates were noticed for patients older than 70 years of age, those who underwent total gastrectomy, tumors involving the entire stomach or greater than 10 cm in diameter, a macroscopic diffusely infiltrative pattern, adenosquamous histologic type, positive surgical resection margins, or lymph node metastasis. None of the above poor prognostic features were identified in patients with early gastric carcinoma group except for those older than 70 years of age. Although lymph node metastases were present in 10% of early gastric carcinomas, this feature did not impart a poor prognosis. Patients with advanced carcinoma grossly resembling an early carcinoma had an intermediate prognosis, suggesting the existence of a developmentally midstage lesion between early and advanced carcinoma. CONCLUSIONS: The study illustrates that the most important role for clinicians treating with gastric carcinoma should be early detection and aggressive surgery for resectable tumors, followed by detailed pathologic examination.

Coincident occurrence of granular cell tumor of the stomach with an early gastric carcinoma.

In a 41-yr-old Japanese woman, a rare coincident lesion composed of granular cell tumor and early gastric adenocarcinoma was detected in the stomach. Beneath the poorly differentiated adenocarcinoma almost limiting to the mucosa, the granular cell tumor measuring 1.2 x 0.8 cm was spreading mainly in the submucosa without forming polypoid nodule. To the best of our knowledge, this is the first published report on this type of coincidence. Immunohistochemically, the cells of the granular cell tumor were strongly positive for S-100 protein, but negative for muscle markers (HHF 35, desmin), some of which connected with perineural Schwann cells surrounding small vessels in the submucosa. These features suggested that granular cell tumor in our case arose from Schwann cells surrounding small vessels in the submucosa of the stomach.

Depressed adenoma of the stomach, revisited. Histologic, histochemical, and immunohistochemical profiles.

For 52 patients with depressed adenomas of the stomach, histopathologic studies were done on 56 tumors and for 43 of them, histochemical and immunohistochemical features were examined. In addition, nondepressed adenomas (n = 57) and the depressed type of early gastric adenocarcinomas of the well-differentiated variety (n = 44) were studied as the controls. Depressed adenomas in the majority (73%) involved the entire thickness of the mucous membrane of the stomach with tubules of atypical epithelium, presenting a severe grade in many of the cases (41%). Paneth's cells were found in cases of a depressed adenoma, in significantly higher percentages (61%) than in those with a nondepressed adenoma (P less than 0.01). The frequency of cases with argyrophil cells was also higher in depressed adenoma (63%) than in nondepressed adenoma (36%) or in cases of early gastric carcinoma (32%). Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 were noticed in tumor cells, immunohistochemically in 28% of the cases with depressed adenoma, the frequency being intermediate between cases of a benign nondepressed adenoma (6% for both CEA and CA 19-9) and cases of early gastric carcinoma (71% for CEA and 66% for CA 19-9). No difference was noticed in lectin reactivity and mucin content between depressed and nondepressed adenomas, whereas tumor cells in the early depressed carcinoma had a higher lectin reactivity and less mucin content than those seen in the adenomas. It would thus appear that depressed adenoma is a benign neoplastic lesion; however, the malignant potential of this lesion is somewhat higher than the nondepressed counterpart, as indicated by the immunoreactivity to tumor markers and follow-up results reported by colleagues previously.