This multimodal treatment of locally advanced gastric cancer provides reasonable 3-year survival compared with historical data, but at a considerable cost in terms of morbidity and mortality.

A 53-year-old man was examined because of mild anemia (hemoglobin [Hb], 11.6g/dl) in August 1996. He had undergone pyloric gastrectomy with Billroth-I reconstruction for perforated benign gastric ulcer in 1988. Gastric transillumination and endoscopy showed comparatively soft, giant fold-like protruding lesions spreading over the entire residual stomach, and biopsy revealed the lesions to be malignant lymphoma. X-Rays of the large intestine and colonoscopy with biopsy demonstrated Borrmann type 2 highly differentiated adenocarcinoma in the upper rectum. At laparotomy in November 1996, a tumor was observed throughout the residual stomach. Lymph nodes were enlarged around the stomach and along the common hepatic artery and splenic artery and in the hepatoduodenal ligament. Total gastrectomy with splenectomy and purging of the lymph nodes was performed, in addition to a lower anterior resection of the rectum for the rectal cancer. The surgical specimen, which consisted of a 12 ϫ 9-cm gastric stump, showed giant fold-like protruding lesions occupying the entire residual stomach (Fig. 1). Histological examinations revealed large lymphocyte-like cells with a round or cleaved nucleus infiltrating across the proper muscle layer from the mucous membrane of the stomach wall. Similar cellular infiltration was also observed for lymph nodes nos. 1, 2, 3, 4sb, 8a, 10, 11, 12, and 272 (lymph nodes along the iliac artery). According to the results of immunohistological studies, the tumor was positive for B-cell markers, i.e., CD20 and CD45RA, and negative for T-cell markers, i.e., CD3 and CD45RO. In addition, both heavy-chain immunoglobulin IgM and light-chain k were strongly and monoclonally positive. These features were diagnostic of B-cell lymphoma of the diffuse, large-cell type. Helicobacter pylori microorganisms were demonstrated at the luminal surface of the tumor. The histology of the rectal cancer was highly differentiated adenocarcinoma

According to "General Rule for Clinical and Pathological Record of Colorectal Cancer", 33 poorly differentiated adenocarcinomas of the colon and rectum among 569 resected colorectal cancers were clinicopathologically studied, comparing to the most common 355 well differentiated adenocarcinoma. Poorly differentiated adenocarcinomas represented as low as 5.8% of all cancers. When compared to well differentiated adenocarcinomas, poorly differentiated ones were more frequently found in the colon, especially remarkable in the right side, and macroscopically those predominantly included infiltrating ulcer types. Hepatic metastasis was found in a rate of 21.2%; lymph node metastasis, 66.7%; and 27.2% of positive lymph nodes were of the 3rd group of lymph nodes. Invasion depth of s (a2) and si (a1) were found in 81.8%; lymph vessel invasion in 97%; and venous invasion was positive in 87.9%. Compared to well differentiated adenocarcinomas, poorly differentiated adenocarcinomas showed significantly high rates in all items, namely, poorly differentiated adenocarcinomas were in more advanced stages such as stage IV and V. Curative resection rate was as low as 54.5%. Five-year survival rate was also low (38.4%) in all 33 cases, but was 59.6% in curative resection cases, that did not significantly differ from 75.1% in well differentiated adenocarcinoma cases.

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